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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Y Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas;CA 95035 Manteca,CA 95336 <br /> Phos (925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax x;325)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> s is Gas&Fjecir'= <br /> MAILING ADDRESS ,g �{ <br /> rc '}`Battle Street,Mpil B24A `t 3C— <br /> sSTATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sam Fri CA 34120 U GLOVES ❑GOGGLES U RESPIRATOR L1 HARD HAT <br /> PHONE <br /> (415)973-37730 TY-VEK O OTHER <br /> 'CONTACT PERSON <br /> Robert SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> G CERTIFICATION:I hereby 4Y t the above named material is not a hazardous - <br /> y SFW _ �Nted by 40 CFR.Part 261 or.title a California code of regulations,has been property - <br /> ssified,and packaged,and is in proper condition for transportation a-,cording to applicable <br /> i X�ID;11 the waste Is a treatment residue of a previousy restricted hazardous.waste <br /> }arid D sposat Restrictions,I tardy and warrant that the waste has been treated in RECEIVING FACILITY <br /> - with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined b)' <br /> PE: <br /> t)�OSAL O SLUDGE <br /> _ UCTION U WOOD <br /> O"OTHER <br /> L WASTE <br /> F1 G FACILITY <br /> t drstcr Shia Li3T3i1c0P' w .n <br /> 1 <br /> ' ORTER NOTES 1%EiICLE D�E13SE €R 'TFll7 IiIBER <br /> pDRESS <br /> pqN STATE,ZIP <br /> CA 95492p <br /> `{ SHONE END DUMP BOTTOM DUMP TRANSFER <br /> r* <br /> �� x � : 838-1413 i ❑ ❑ <br /> GNATURE OF AUTUO AZEQ AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# ?R q Tn"h Q A <br />