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' ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Salley Road 12310 San Mateo Road 1609 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)45&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 . <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I PHONE 0 GLOVES O GOGGLES U RESPIRATOR ,U HARD HAT <br /> �' ' `• ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> I SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> I GENERATOR 5 CERTIFICATION 1 hereby certify that the above named Miens]is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tttte 22 of the Calrtomia code of regulations has been property <br /> described 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 Previously restricted hazardous waste <br /> subject to the tarrd Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pari 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> I ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> r , <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS . <br /> I <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATUREOF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> I _ '- ❑ ❑ ❑ ❑ <br /> cuBlc 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 /> I is true and accurate <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> I ❑ASH <br /> ❑ SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO 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 /> SAT Fc rnpv MANIFEST# <br />