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❑ Keller 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 Halt 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 0 GLOVES ❑GOGGLES U RESPIRATOR Q HARD HAT <br />' U TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br />' GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> wasteas defined by 40 CFR Part 261 or title 22 of the California code of regulations las been property <br /> descnbed classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations ANCI,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> subfect 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 /> ID DISPOSAL Q SLUDGE <br /> U CONSTRUCTION U WOOD <br />' ❑DEBRIS Q OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> r <br />' TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS - <br /> CITY, STATE, ZIP <br />' PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Q ❑ ❑ <br /> SIGNATURE OF AUTHORIZED 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 <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 U-SOIL <br /> ❑ CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER DEBRIS <br /> NON-FRIABLE <br />' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br />' ❑ASH <br /> U SPECIAL OTHER <br />' SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIOR TO 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 /> MANIFEST# <br /> SALES COPY tv <br />