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❑ Keller Canyon ❑ Ox Mountain U Newby Island AlForward <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 /> w-CW&Electric <br /> MAILING ADDRESS <br /> ITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> '1�Sx Fra=isro,Crt°�412d: O GLOVES Q GOGGLES Q RESPIRATOR O HARD HAT <br /> PHONE <br /> 9 -3, D TY-VEK' Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Gray <br /> SIGNATURE OF AL,(THORIZE AGENT/TITLE DATE S /V <br /> ;f �GENERATOR'S CERTIFICATION:f h eby certify that the above named material is not a hazardous. <br /> W; as defined by 40 CFR Part 261.or fitle 22 of the California code of regulations,has been property : - <br /> aeschDed,classified and packaged,and is in proper.condition for transportation a-:cording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previousty restricted hazardous waste <br /> kSublect to the Land Disposal Restrictions,I certify 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 /> yt40 CFR Part 261: <br /> {WASTE TYPE <br /> ISPOSAL, - Q SLUDGE <br /> kCONSTRUCTION Q WOOD <br /> Q:DEBRIS Q OTHER <br /> L-J SPECIAL WASTE <br /> G NERATING FACILITY <br /> C. Dlehy,Leat irs <br /> ORTER NOTES:`, VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> RESS <br /> 9'I3 !3x ae citv <br /> STATE,ZIP <br /> ONE, ' END DUMP BOTTOM DUMP TRA ER <br /> i4i� X38-1. r' ❑ ❑ <br /> IGN U f}AUTHO ZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> f <br /> 5 <br /> 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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> O ASH <br /> )s - Q SPECIAL OTHER <br /> SCHEQULING 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 /> GENERATOR COPY MANIFEST# <br /> 289622 <br /> 96 <br />