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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 /> GENEFJATOR Cox - WASTE ACCEPTANCE NO. <br /> ®UI AI <br /> MAILING ADDRESS _-0 7 <br /> Gt1 � f <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> LFAIA �° �� GLOVES ❑GOGGLES Q RESPIRATOR Q HARD HAT <br /> PHONE <br /> ❑TY-VEK Q OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Vjp-t6l/-r TAF [ �•S <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATErJ, <br /> GENERATO S CERTIFICATION I hereby certify that the above named material Is not a.lhazardous <br /> waste as defined by 44 CFR Part 261 or title 22 of the Califomla code of regulations,has been property <br /> described clessiffed and packaged,and is In proper condition for transportation a^cording to applicable <br /> regulations AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Lend 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 /> Q DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> O DEBRIS OTHER <br /> ❑SPECIAL WASTE ' �1 L <br /> GENERATING FACILITY K <br /> TRANSPORTER4 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> egitADDRESS <br /> CITY,STATE, ZIP % <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 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 /> #E-MARKS US-OIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM THE DAY PRIORTO 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 /> MANIFEST#150478 <br /> G�fw"'PIERATOR COPY <br />