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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ] Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill andfill <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 /> GENERATOR:_ WASTE ACCEPTANCE NO. <br /> Pack Gs&Ek-cftic <br /> MAILING ADDRESS <br /> 77 Bae B24A . <br /> 431 -4 <br /> CITY,STATE,ZIP. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sm iFTaxtdsw C.4 94120 0 GLOVES 0 GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE <br /> 4I 973-3773 0 TY-VEK. 0 OTHER <br /> CONTACT PERSON <br /> Grp SPECIAL HANDLING PROCEDURES: <br /> -RobedSIGNATURE OF AUTHORI ED AGENT/TITLE DATE <br /> A'k <br /> GENERATOR'S CERTIFICATION:I hereb iy that the above named material is not a hazardous: <br /> 11wil&-- <br /> waste as defined try 40 CFR Part 261 or tifle 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper edition for transportation a',cording to applicableregulations;AND,If.thcwaste is a treatment residue of a preylously restrkted,hprerdous westssubject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated inRECEIVING FACILITY <br /> azcMdance with the requirements of 40 CFR Part 268 and is no longer a hazardous-waste as dermad by40 CFR Part 261.ASTE TYPE: <br /> -0 DISPOSAL ❑SLUDGE <br /> LI CONSTRUCTION OWOOD <br /> D DEBRIS J OTHER <br /> 08PECIAL WASTE <br /> ENERATING FACILITY Y <br /> 1 RANSPORTER - - NOTES: =JE rCLE'EICERSENIJ1418ER " `'TRUCI MBEFi -- <br /> t <br /> - <br /> ADDRESS . ' <br /> i <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP : TRANSFER <br /> ^' (707)83s-1407 I] ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL FF(S) FLAT-BED VAN DRUMS <br /> r �. ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> ;:lea <br /> 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 /> O SOIL <br /> EMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> 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 /> C F:NFRATOR COPY MANIFEST# 9 Q Q rz a 9 <br />