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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward i <br /> I Sanitary Landfill,, Sanitary Landfill Sanitary Landfill �Y Landfill <br /> 901 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 /> Q GLOVES 0 GOGGLES U RESPIRATOR CI HARD HAT <br /> PHONE k <br /> ❑TY-VE}C t]OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> f <br /> f }fA 1,u <br /> I GENERATORS CERTIFICATION I he by-certty that the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cording to apphcabie <br /> regulations AND,It the waste Is a treatment residue of a previously restncted hazardous waste <br /> subject to the land Disposal Resinctions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> I 40 CFR Part 261 <br /> WASTE TYPE <br /> D DISPOSAL U SLUDGE <br /> U CONSTRUCTION 0 WOOD <br /> I 0 DEBRIS U OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> I CITY, STATE, ZIP - <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> z <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 /> I is true and accurate <br /> DISPOSE OTHER <br /> 0 SOIL <br /> aEMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑waoD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a 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# .� x <br />