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❑ Keller Canyon ❑ Ox Mountain El 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)9824298 <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 /> - Pwtfsc Gas-f El&ftic <br /> MAILING ADDRESS y <br /> 5, a t, Stop B24R Y <br /> EITY,.STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sazt ra <br /> CA94120 <br /> PHONE- O GLOVES O GOGGLES 'O RESPIRATOR O HARD HAT <br /> O TY-VEK D OTHER <br /> Ua CONTACT PERSON <br /> Roi,�st Gns_y SPECIAL HANDLING PROCEDURES: <br /> ` <br /> SIGNATURE OF AUTHO ED AGENT/TITLE DATE <br /> f <br /> GENERATOR'S CERTIFICATION:I her certify that the above named material is not a hazardous - <br /> waste as defined by 40 CFR Pad 261 or title 22 of the Caldomia code of regulations,has beenproperty ' <br /> described,classified and packaged,and is kr 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 Land Disposal Restrictions,I certify and warrant that the waste has been treated ai RECEIVING FACILITY - <br /> y accordance with the requirements of 40 CFR Part 268 and is,no longer-a hazardous waste as defined by <br /> 40 CFR Pad 261- <br /> WA TE TYPE: <br /> DISPOSAL O SLUDGE <br /> O CONSTRUCTION` O WOOD <br /> S O OTHER - <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> I RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS f� <br /> �;: $2(31+ 3 •te Ct,urt -- 1 ,', �r.�-,� <br /> CITY,STATE,ZIP <br /> -,TCA 9543' <br /> ` PHONE END DUMP BOTTOM DUMP TR S R <br /> 70`d3&'38-1407 ❑ ❑ <br /> SIGNATURE OF O , AGENT'-OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> 01. ❑ ❑ ❑ ❑ <br /> 112 <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 /> a` O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> _ DNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 1 <br /> O ASH ' <br /> ❑SPECIAL OTHER <br /> r-.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 /> r_c rronTno rnov MANIFEST# Q 0 t7 tk rl 0 <br />