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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 0 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 /> Po^ifi--Gas&Flo_-hrk <br /> MAILING ADDRESS <br /> 77 Beale heat,,t Stop B24A 4 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Say Ftawisco,CA94# C O GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> PHONE <br /> 1 '73 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Robert Gm SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AWTHORIZED AGENT/TITLE JDATE <br /> Al <br /> GENERATOR'S CERnFICATION:.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 properly <br /> -described,classified and packaged,and,is in proper condition for transportation a-cording to applicable <br /> regulations;AND,if the waste Is s treatment residue of s previously restricted hazardous waste <br /> subjecttothe LandDiSposalResUictions,:tcertify and warrant that the waste has been trQatedin RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is.no longer a hazardous waste as defined by <br /> f A0 CFR Part 261_ <br /> (I'ASTE TYPE: <br /> "ISPOSAL O SLUDGE <br /> 'OiCONSTRUCTION Q WOOD <br /> Lx <br /> O DEBRIS O OTHER <br /> OSPECIAL WASTE <br /> GENERATING FACILITY <br /> €.-ATHROP <br /> R I ER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DDR <br /> CITY,STATE,ZIP <br /> e ,W 4*.CA 93442 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> p 707 M- -140 7 ❑ ❑ <br /> SIGNATURE OF THORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> =, a ❑ ❑ ❑ ❑ <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 /> is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS, <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> U ASH <br /> Q SPECIAL OTHER <br /> 5, HEDUUNG 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# 28961 E <br />