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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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> PiE&Gas&Ethic <br /> MAILING ADDRESS <br /> 77 F;i-eef,Mna Stop B24.A 43 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San t ra, icaCA94120 U GLOVES D GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> (415)973-37,,-7 3 U TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robert GM <br /> SIGNATURE OF AUTHORIZEP AGENT TITLE DATE <br /> 4 GENERATQR'S.CERTIRCATION 1 herebj. that the above named material is not a;ZardouL <br /> ,r waste as defined by 46 CFR Part 26t or titlg 22 of the California code of regulations,has been property <br /> desixibed,dassified and packaged a4A ..k"'.oper condition for transportation a-,cording to applicable <br /> reg AND,If the waste Is a[rest iiertt iealdue of a previously restricted hazardous waste <br /> e`.LandChsposalRestnctions,l'certifyandwarrantthatthewastehasbeentreatedin RECEIVING FACILITY <br /> with the requirements of 40 CFA Part 268 and is no longer a hazardous waste as defined by <br /> �p SFR Part 261. <br /> 4 i4S CE TYPE: <br /> DISPOSAL U SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> LIDEBRISC)OTHER <br /> Q SPECIAL WASTE <br /> t tali LATHROP <br /> , c, NOTES: VEHICLIE LICENSE NUMBER TRUCK NUMBER <br /> Y* <br /> CDDRESS <br /> 01D�Be�te C _ <br /> 1TY_STATEZIP <br /> :? ` . ;_A 4349? <br /> ' PHONE' END DUMP BOTTOM DUMP TRANSFER <br /> (707)839-1407 _.�� ❑ ❑ <br /> SIGNATURE OF #i0,f ZEQ AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS; <br /> �. ❑ ❑ ❑ ❑ <br /> Kd' <br /> CUBIC YARDS <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 /> a 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 /> i, <br /> U ASH <br /> U SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> GENERATOR COPY MANIFEST# g Q Q fNn n <br />