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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill 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 /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Fcfi'xc CrFlectric <br /> MDRESS -9 <br /> 7 LING Beale S# ?,%A Stop B24A 431-4 <br /> CITY,STATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sttlt FrarociscoPA 94120 O GLOVES U GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> J415)973-3773 U TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robtctt Gra <br /> SIGNATURE OF AIJTHORIZEQ AGENT/TITLE JDATE sC . N <br /> 1115a <br /> GENERATOR'S CERTIFICATION:I hereby c t the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 2W the Califomia code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> •. 'regulations;AND,If the waste is s treatment residue of a previously restricted haxerdous waste <br /> '.`subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> '`.40 CFR Part 261, <br /> WASTE TYPE: <br /> ❑DISPOSAL ❑SLUDGE' <br /> ❑CONSTRUCTION O WOOD <br /> O DEBRIS ❑OTHER <br /> O SPECIAL WASTE. <br /> GENERATING.FACILITY <br /> aP drat t•,u' L.ATHROP <br /> NOTES: VEHICLE LICENSENUMBER TR IC NUMBER' <br /> ADDR_ESS <br /> S20 D mBerfte.:i'omt <br /> rt. CITY,STATE;ZIP <br /> { V0.9549 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Q07 11 M-1407 N ❑ ❑ <br /> S GNATURE QF AUTHORIZED AGENT O DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> Ll <br /> t <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 /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 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),0 0 C 0 Q <br />