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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 99.99 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phoria(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 /> PR <br /> CTM it-E <br /> MAILING ADDRESS 43 <br /> 14 <br /> 77.Beale Street,Mail Stop B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Rr,Ecxtisco CA9Q12L► <br /> PHONE 0 GLOVES O GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> t (415)473.3773 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED IZED AGENT/TITLE DATE Aj 6�, ) <br /> t <br /> 41161, <br /> GENERATOR'S CERTIRGATION l liar certify that the above named material is not a hazardous <br /> _waste-as defined by 40 CFR-Par1261 or:title 22 of the California code of regulations,has been property <br /> dascr lassified and packaged,acid is.in proper condition for transportation a-cording to applicable <br /> regulafiotts,AND,If the weals la a treatrtient residue of s previously restricted hazardous waste <br /> subject to the�aitd osposal gestr c ions.1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accrordance-wdh dw requireri}ents of 40 CFR Part 260 and is.no longer a hazardous waste:as defined by <br /> 40 CFR Part 261. - <br /> r <br /> WASTEr TYPE, <br /> DISPOSAL O SLUDGE <br /> R CONSTRUCTION <br /> U DEBRIS , ❑OTHER <br /> 4ySPECAL1NSTE' <br /> GE�TCi1ITY <br /> LATHItOP <br /> -e, <br /> "Am 'y NOTES: 'VEHICLE UCFF.NSENUMBER TR�1CIi NUMBER <br /> Qa��ss <br /> kTY:`STATE,ZIP �7IJ <br /> N ia)6or,CA 4 <br /> PHONE 1 END DUMP BOTTOM ni UP TRA SFER <br /> 707 1538-3407` ❑ ❑ <br /> SIGNATURE OFAUTHQ IZED AGE, TOR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> t, CUBIC YARDS <br /> hereby certify that th�_pbove 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 /> SCHEDULINGMUST 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 /> GENEFkTOR COPY MANIFEST# 289594 <br />