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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 /> 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 /> VGENERATOR . WASTE ACCEPTANCE NO. <br /> FkTtric <br /> G ADDRESS <br /> 43 <br /> le Ste,MaH St, I324A <br /> TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sad rmcis .GA9412t? U GLOVES O GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> 4I )977 3-3773 O TY-VEK O OTHER <br /> P <br /> ;{ CONTACT PERSON <br /> 1tolic-1SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICAT PMI herebythat the above named material is not a hazardous -. <br /> waste as defined by 40 CFR Part 261 or Oftthe California code of regulations,has been property <br /> desciibed,classified and packaged,am isin proper ciDngr ion for transportation a-cording b applicable <br /> regulations;AND,If the waste la o trestment residue at s previously restricted hazardous waste <br /> subject to the land-Disposal Restrictions;I -ffy And warrant that the waste has been treated in, RECEIVING FACILITY <br /> accordance with the requirements of 40.CFR Part"268 and is no longer a hazardous waste as defined by <br /> „. ,46GFR.Pail 267. - - - - <br /> '� WASTE TYPE: <br /> DISPOSAL 0 SLUDGE <br /> CONSTRUCTION' q WOOD <br /> UDE O OTHER <br /> D,SPECIAk IfVASTE <br /> E�IEfiATLG / 1CTY <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 3 <br /> C TY,.S <br /> �+iszu',4A.9543� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (70n ❑ ❑ <br /> ,GNATURE OF 4WHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS' <br /> a5' ! 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 /> EMARKS <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 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# 2 8 9 5,qG <br />