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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island C] 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)456-9600 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 /> LINGA DRESS <br /> FY STATE,ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> RHONE Q5'"103 D GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> �1 0 TY-VEK ❑OTHER <br /> CONTA P S <br /> SPECIAL HANDLING PROCEDURES' <br /> SIGNATUR ORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify drat"above named rnetarial is not a hazardous <br /> waste as defined by 4o CFR Part 261 or title 22 of Gre cafdomea code of regulations has been properly <br /> described classified and packaged and Is,n proper conddion for transportation a-cording to applicable <br /> regulations AND,It tht:waste is a treatment residue of a provlousty restricted haxerdous waste <br /> subject to the Lord Disposal Resficbms I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the regwrernents of 4D CFR Part 258 and is no longer a hmrdous waste as defined by <br /> a4 GFR Part 261 <br /> WASTE TYPE <br /> Q DfSPOSAL 0 SLUDGE <br /> •CONSTRUCTION ❑WOOD _ <br /> •DEBRIS 0 OTHER <br /> O SPECIAL WASTE - - - - <br /> GENERATING FACILITY <br /> '876 Country Ct'ub Sled, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER LICK NUMBER <br /> ADDRESS <br /> CITY, ST <br /> PHON GA 96828 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNAT ORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS Yards <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 /> 14EMARKS <br /> ❑cONST13ucTION <br /> F=ACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRiORTO 3 00 P.M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUB.IEC' <br /> ' TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST 4 9;9 Q 01 <br />