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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(92'1)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> JGENERATOR c WASTE ACCEPTANCE NO. <br /> MAILING ADD 5S � - <br /> CITY,S ATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> HONE <br /> Q GLOVES 0 GOGGLES 13 RESPIRATOR E HARD HAT <br /> Q TEK 0 OTHER <br /> Ic <br /> ONTA T PERSON Y VN <br /> ,-- it a SPECIAL HANDLING PROCEDURES <br /> SIGNATJREJeF AUTHORIZED AQ,,ENT/TI E DATE <br /> J40 <br /> Contractorlf None <br /> A S CERTIFiCATI reby that the above named material ps not a hanardousas fined by+IOCFRP 26i ar tNie of the California Code of regulations has been properly <br /> Cdaealfied andand uc proper eondruon for trsnsportatron a cording to eppi�cable <br /> ANG.K The is a treatment residua of a prevlonsfy restricted hazeno w waste <br /> the Land Deposal Restnctions I certify and warrant that the waste has been treated mRECEIVING FACILITY <br /> with the rKppnowts of 40 CFR Part 268 and Is no lager a hazardous waste as defined bycF'RPad261 Forward Landfill <br /> WASTE TYPE <br /> �tDISPOSAL Q SLUDGE q , <br /> ❑CONSTRUCTION 0 WOOD Manteca CA 9'5$ S- <br /> 0 DEBRIS Q OTHER <br /> Ck SPECIAL WASTE <br /> GENERATING FACILITY <br /> u <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBERTRUCK NUMBER0115 1-norpe U11 Ir <br /> ADDRESS F n C. ��7 Z <br /> cx 357 <br /> CITY,STATE, ZIP <br /> Lodz CA 95241-0357 <br /> ENIPHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)SRS-617S <br /> _ r <br /> IGNATURE OF AUTHORIZED AGENT OR DRIVER DAVE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 7k <br /> CUBIC YARDS <br /> 1hereby 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 /> EMARKS <br /> Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> v NON-FRIABLE <br /> ASBESTOS <br /> GNAtURE X?F AUTHORIZED GENT DATE <br /> / f O WOOD <br /> ' Q ASH <br /> On CIAL OTHER <br /> f <br /> UFR1E#9NSAf_ <br /> EDNG(MUST BE MADE k� IORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST# 0 0 n O n n <br />