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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br />' Sanitary Landfill, Sanitary Landfill, Sanitary Landfill Landfill <br /> 901 Bailey Road r 12310 San Mateo goad 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> 6 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) 982-1409 <br /> NON-HAZARDOUS WASTE MANIFEST <br />' GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> PHONE L]GLOVES ID GOGGLES ❑RESPIRATOR 4p HARD HAT <br />' ❑TY-VEK U OTHER <br /> CONTACT PERSON <br /> i SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * a <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 t:aa lomia code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cording to apphcable <br /> regulations AND.If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal Resinctions I caddy and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 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 /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS � A <br />' CITY STATE ZIP <br /> I PHONE ENaDUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> I ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> I ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING 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 /> SALES COPY MANIFEST# 4} Q 1 r11 <br /> x� <br />