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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 /> Gas r,x. .t.iiCl±tv <br /> MAILING ADDRESS <br /> 77 Beale Street MA Corte B24A 43 i"I— <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> s San Fratir_.iQeri, Ca 941.05 <br /> O GLOVES U GOGGLES Q RESPIRATOR O HARD HAT <br /> r` PHONE <br /> 1—' —' Q TY-VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert GTav <br /> SIGNATURE OFALJTHORIZ ,DAGEN�T//}TITLE DATE l ` i <br /> i� <br /> 'iA. <br /> GENERATOR'S CERTIFICATION:I her:by=that the above named material is not a hazardous <br /> ;-waste as defined by 40 CFR Part 261 or title 22 of the California code d regulations,has been property <br /> desodbo,classified and packaged,and is in proper condition for transportation a-cording to applcabto <br /> regulations;AND,H Hre waste Is a treatment residue of a prevlousty restricted hazardous wi�ste <br /> subject to the Land Disposal Restr coons,I certify and warrant that the waste has been treated' RECEIVING FACILITY <br /> _ "accordance with the requirements of 40 CFR Pad 266and is no longer a hazardous waste as nod by <br /> 40 CFR Part 261. <br /> ,}NAS E TYPE: <br /> E DISPOSAL <br /> CONSTRUCTION O WOOD <br /> €B 'IS D OTHER <br /> roz frGIAL WASTE <br /> TING FACILITY <br /> iz ill: i : l..ailrop <br /> f� 1TER M NOTES,' VEHICLE LICENSE NUMBER NOTES ' <br /> � esHeste �'i•��aorEation � -�!?(� <br /> Yom' <br /> PDRESS <br /> 82 aPst� <br /> CITY;STATE,ZIP l` <br /> t <br /> Windsor, CA-95492 <br /> I <br /> PHONE END QYMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-O F(S) FLAT-BED VAN DRUMS <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: (O BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> :)t FACILITY TICKET NUMBER DEBRISU NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> ' HEDUUNG MUST BE MADE PRIORTO 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 /> rrt=nlGRGTnP('nPY - MANIFEST# 0 Q 1 0 r:) <br />