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❑ Keller Canyon ❑ Ox Fountain ❑ Newby Island [❑ Forward Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 ' Phone(925)458-9800 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 982-4298 Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 NONHAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. MAILING ADDRESS yy4]� CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT PHONE Q GLOVES D GOGGLES a RESPIRATOR p HARD HAT 0 TY-VEK O OTHER CONTACT PERSON SPECIAL HANDLING PROCEDURES ISIGNATURE OF AUTHORIZED AGENT/TITLE DATE * , , A 14 , IS - e GENERATORS CERTIFICATION i hereby certify that the above named matenal is not a hazardous waste as defined by 40 CFR Part 261 or title 22 of the Cal,lomia code of regulations has been property described ciassified and packaged and is in proper condition for transportation a-cording to applicable regulations AND,It the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions I ce"and warrant that the waste has been treated in RECEIVING FACILITY accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by 40 CFR Part 261 WASTE TYPE ❑DISPOSAL D SLUDGE ID CONSTRUCTION D WOOD Q DEBRIS D OTHER ra SPECIAL WASTE GENERATING FACILITY TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER ADDRESS CITY, STATE',ZIP IPHONE - END DUMP BOTTOM DUMP TRANSFER SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS ❑ ❑ ❑ ❑ CUBIC YARDS hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) I is true and accurate DISPOSE OTHER dSOIL MARKS D CONSTRUCTION FACILITY TICKET NUMBER DEBRIS ❑ NON-FRIABLE ASBESTOS SIGNATURE OF AUTHORIZED AGENT DATE D WOOD D ASH D SPECIAL OTHER SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE SALES COPY MANIFEST# e . "