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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill, Sanitary Landfill Landfill <br /> 9.01 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 , <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE t❑GLOVES ❑GOGGLES ❑RESPIRATOR O HARI)HAT <br />' ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> F <br /> f <br />' GENERATOR 5 CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste.as defined by 40 GFR Part 261 or title 22 of the Calriornia code of regulations has been properly <br /> described classified and packaged and is in proper condition 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 accordance with the requirements of 40 CFR Pan 266 and no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION Cl WOOD <br />' ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS <br /> CITY, STATE, ZIP <br /> Y <br /> IPHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ICUBIC 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 /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> T ❑WOOD <br /> ❑ ASH <br /> ❑ SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIOR TO 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 /> sal F4 rnPv MANIFEST# <br />