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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 /> i• 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 /> RRei>u: GAs&Eket is <br /> MAILING ADDRESS <br /> 4314 <br /> Beale fte4 Mad fW B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San FftnciscoCA 94120 <br /> PHONE U GLOVES Q GOGGLES O RESPIRATOR O HARD HAT <br /> 4 -3773 <br /> '' Q TY-VEK U OTHER <br /> CONTACT PERSON <br /> RobeitGray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF THORIZED A T/TITLE DATE NO/V f <br /> �/1 <br /> f � <br /> V u K/ �JlriG r U"1 <br /> GENERA OR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified 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 prevlously restricted hazardous waste - <br /> t 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 266 and is no longer a hazardous waste as defined by <br /> t..40 CFR Part 261. <br /> WASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> r <br /> O-CONSTRUCTION D WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENF)ATING FACILITY <br /> �;: .. „ <br /> ;'TRU/CC NUMBERRTR ` NO , Vr-I0 <br /> DDRESS` <br /> 32f!D ft CC41rt <br /> STATE,ZIP <br /> or e <br /> PHONE' END DUMP BOTTOM DUMP TRANSFER <br /> 70 838-1407 rx ❑ ❑ <br /> Ar <br /> r IGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLE-OFF(S) FLAT-BED VAN DRUMS <br /> � LI <br /> �;, � ,�'� ��� /��_ -/�-opt <br /> a&y <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 /> ❑ <br /> EMARKS SOIL <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 MADE PRIOR TO 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# 0 0() 17 0 0 <br />