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t, ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ® Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Barley 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 /> 16 Phone(925)458-9800 Phone (650)726-1819 Phone(408)945-2800 Phone(209)982-429E <br /> Fax(921)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR L WASTE ACCEPTANCE NO. <br /> MAILING ADD SS <br /> Cr STY, ATE ZIP REQUI D PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> 0 GLOVES U GOGGLES ❑ RESPIRATOR HARD HAT <br /> O TEK O OTHER <br /> COY V <br /> NTA 7 PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE F AUTH RIZED A N /TI E DATE <br /> * Contractor 1 None <br /> KS CERTIFiCA7I ropy that the above named material w not a hazardous <br /> as Rnsd tty 40 CFR P x or title a1 the Califomra code of regulations has been properly <br /> ctanffied and gad and is proper condnion for tranaportatwn a-cordrng to appUcable <br /> Aktk 11 the is a treahrmrtt residue of s previously rastrictad hazardous waste - <br /> ndDisposal Restrmtons I certify and warrant that the waste has been treated m RECEIVING FACILITY <br /> 40 CFR Part <br /> with <br /> rPgwrarnente 0140 CFR Part 2118 and Is no longer a hazardous waste ns detmed by <br /> 61 <br /> WASTE TYPE Forward Landfill <br /> O&DISPOSAL O SLUDGE 9999 S All Pt 9 n Rd <br /> L)CONSTRUCTION UWOOD Manteca, CA 952of- <br /> O DEBRIS Q OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ATunorpe 011 , <br /> DDRESS <br /> .13. CR 3.5 � <br /> CITY,STATE, ZIP <br /> Lodi CA 95,�s1-0357 <br /> NotPHONE END DUMP BOTTOM DUMP TRANSFER <br /> IGNATURE OF AUTHORIZED AGENT OR DRIVER DAVE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * ❑ ❑ ❑ ❑ <br /> f <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoin <br /> Is true and accurate. g DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS <br /> O SOIL <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Z Q NON-FRIABLE <br /> GNAAJRE OF AUT ORIZED GENT ASBESTOS <br /> DATE <br /> O WOOD <br /> r j DASH <br /> i <br /> / r CIAL OTHER <br /> HBDULING MUST BE MADE F��tIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REOFUSAt UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br />