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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 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 /> 4AD 140M X4 LKWAGO <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O GLOVES 0 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTFJCRIZED AG T 1 TITLE DATE <br /> GnENERATOR'S C£FRIFICA4- Ugb.anamed material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Ode 22 Of the omia coded nrgulad" has been properly <br /> described,classified and packaged and Is in proper canddron for transportattan axorQIng to applicable <br /> regutatwrra,AND it the waste Is a treatment residue of a provbualy neatricted hezendocrs wastA <br /> sut�jed to the Land Disposal Restrictions I cartiy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and w no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WA TYPE <br /> DISPOSAL ❑SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> ❑ EBRIS U OTHER <br /> ❑ CIAL WASTE <br /> GENERATING FACILITY <br /> l to weNtRORMa St, STOCK PON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br />' 51 <br /> CITY, STATE,ZIP <br />' PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE F AUTHORIZED AGENT OR DRIVER ©ATE ROLL-OF 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 />' ❑SOIL <br /> 1=MARKS <br /> ❑conlsrRucTloN <br />' DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNA RE OF O D AGENT DAVE <br /> ❑WOOD <br /> ❑ASH <br />' * / SPECIAL OTHER <br />' SCHEDULING MUST BE MADE PRIORTO 3.00 PM.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 /> -- _-- MANIFEST# I fir;7 1�7Q 9 <br />