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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 Halt 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 /> r; <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> F c Gas tri Electric <br /> MAILING ADDRESS [� ��qq AA <br /> y SbV4 mail Atop B2 4A / <br /> r <br /> CITY,-STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ._n 8 rr icisco,CA94220 O GLOVES U GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE. <br /> 1413 973-3773 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF A,14THORIZED AGENT TITLE L_ DATE ✓O/V <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material is not a hazardous. <br /> 1_ waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> .: <br /> described,.classified and packaged,and is in proper condition for transportation a'cording to applicable <br /> regulations;AND,If d*waste Is a treatment residue of a previously restricted hazardous waste <br /> wbiw to the Card Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> occDrdance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> �40CFA,Part 261- - <br /> = ASTE TYPE <br /> DISPOSAL O SLUDGE <br /> Ct-4INSTRUCTION D WOOD <br /> 2 ERRIs• 0 OTHER <br /> " .,�+�• - .IAL V1(ASTE <br /> TINES • E ��Ty,. <br /> • ry L >i <br /> NOTES. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DDRES <br /> t f <br /> 3?U DeuBesie C tit <br /> CITY;;STATE.ZiP <br /> PHONE.' . END DUMP BOTTOM DUMP TRANSFER <br /> 7 938.1401 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(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: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> 0 <br /> REMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> U 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 /> C;FNFRATnR COPY MANIFEST# j <br />