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❑ Keifer 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(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 /> MAILING ADDRESS y <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES U GOGGLES a RESPIRATOR .,O HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br />' GENERATOR S CERTIFICATION I 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 Caidomta code of regulations has been property <br /> described classified and packaged and cs in proper conddion for transportation a-cording to applicable <br /> regulations AND It the waste is a treatment residue of a previously restricted hazardous waste <br /> subject 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 GFR Part 268 and is no longer a hazardous waste as defined by <br />' 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑ DISPOSAL ❑SLUDGE <br /> •CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY STATE ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> REMARKS ❑SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D WOOD <br /> - ❑ASH <br /> ❑ SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIORTO 3:00 P.M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> S4LFS( n MANIFEST# ; '� ' <br />