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❑ Keller Qaon ElOx Mountain F1Newby Island VT Forward <br /> unitary3_ 11iwfllf " 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 /> 1 aWLLA1+ Gas lX,�LM1�41 L4 <br /> MAILING ADDRESS �nnn- <br /> 77-Beale, Street Mail Code B24A "t7V 7 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San FranGi.3cC`A 94120 U GLOVES O GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY VEK U OTHER <br /> CONTACT PERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE QF AU`rHORIZED AGENT/TITLE DATE <br /> Autllotizcd Amt fitr I <br /> Lki <br /> ifiC(31 &EJ CtFic 1/ J ..............VkT <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1rUl1r <br /> waste as defined by 40 CFR Part 261 or 6Ue 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a'mrding to applicable <br /> regulations;AND,it the waste Is a treatment residue of a previously restricted hazardous 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 M. <br /> WASIE TYPE: <br /> ISPOSAL O SLUDGE <br /> CONSTRUCTION O WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> I ncmnion Dchydraior Thornton <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L=13este'.l'ransportation <br /> ADDRESS <br /> _ .n <br /> CITY,STATE,ZIP <br /> Windsor. CA 95492 <br /> PHONE END DUMPI3. TTOfv1 DUMP TRINSFER <br /> (707)R3R 14P7 L) <br /> SIGNA FAU ZED AGENT OR DRIVER DATE ROLL-OFF(S) FLATBED VAN `D MS _;. <br /> ❑ ❑ a la <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 /> EMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a 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 N 341946 <br />