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❑ Keller Canyon ❑ Ox Mountain U Newby Island f Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill :` ` Landfill <br /> 901.BaileyRoad 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 /> GEN- ,AT_QR WASTE ACCEPTANCE NO. <br /> a, circ <br /> MAILING ADDRESS 3 <br /> 1-4 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 'Ssn ? 'CAg lea 0 GLOVES O GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE- <br /> f O TY-VEK U OTHER <br /> CONTACT PERSON <br /> Rebm SPECIAL HANDLING PROCEDURES: <br /> ^a SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I there that the above named material is nota hazardous - <br /> waste as defined by 40 CFR Part 261 or title.'the C Oftmia code of regulations,has been,property <br /> described,classified and packaged,and is in proper.condition for transportation a-cording to applicable - <br /> regufaEnons; H-the waste Is a treatment residue of a previously restricted hazardous waste . . <br /> rsubject to the t.and Disposal Restrictions,l certify and warrant that the waste has been treated in. RECEIVING FACILITY <br /> "4`accordanop with the requirements of 40 CFR Part 268 and is no longer a hazardouswaste as defined by <br /> q0 CFR�',airt2C>7, <br /> fE <br /> SAL U SLUDGE <br /> { UCTION 0.WOOD <br /> OOTHER <br /> GE�IINC FACILITY <br /> C TRUCK NUMBER <br /> , I <br /> ADDRESS . <br /> Fr: $2CM f� <br /> CITY,STATEi ZIP { <br /> ;WihdwrCA 9343n <br /> PHONE END DUMP BOTTOM DUMP, TRANSFER <br /> (70 i}M-1407 ❑ ❑ <br /> SIGNATUW OF AUTHORIZED APNT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ' ❑ ❑ ❑ ❑ <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 /> U SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE iAADE`PRIORTO 3:00 P.M.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 /> GENERATOR COPY MANIFEST# 28-9 S Q 0 <br />