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U Keller Canyon U Ox Mountain LJ Newby Island Zf 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 /> G&&Tk7cii <br /> MAILING ADDRESS <br /> .: r Bme e mail Stop R24A 4314 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 8au Frana6cD,CA94I20 <br /> PHONE O GLOVES Q GOGGLES Q RESPIRATOR 0 HARD HAT <br /> i' (415)973-3773 0 TY-VEK 0 OTHER <br /> h <br /> CONTACT PERSON <br /> Robeat Care SPECIAL HANDLING PROCEDURES:: <br /> SIGNATURE OF AYTHORIZED AGENT,/TITLE DATE rt�r�/F <br /> f 1 <br /> GENERATOR'S CERTIFICA'nON:t 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 /> desdribed;classified and packaged;and is in proper condition for transportation a cording to applicable <br /> 'regulations;AND,it the waste is a treatment residue of a previously restricted hazardous waste <br /> 11 to.the -Restrictions,I cern and warrant that the waste has been treated in <br /> accord ° '� RECEIVING FACILITY <br /> accordance the requiremeids of 40 CFR Part 266 and is no longer a hazardous waste as defined by - <br /> s 40 CFR Part 261. <br /> WASTE TYPE <br /> ISPOSAL O SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> LlDEBRISU OTHER <br /> U'SPECIAL WASTE <br /> GENERATING FACILITY <br /> V; <br /> LOXID0LA71BROP <br /> NOTES' VEHICL/ELICENSEW TRUCKNUMBER <br /> �;� ADDRESS <br /> T <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707) I Ll L11 <br /> SIGN R F AU OIiIZED AGENT OR DRIVER DATE ROLL OFFS) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I 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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION •� <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE •� <br /> Q WOOD <br /> i <br /> Q 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# 000017 <br />