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I ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island M-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 /> I 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 /> C,ty ATOR WASTE ACCEPTANCE NO. <br /> OR <br /> I MAILING ADDRESS 2328 <br /> NUM M DRAW S <br /> CITY, STATE,ZIPREQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ©GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHO E <br /> U TY VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r <br /> GENERATORS CERTIFICATION I hereby certify that the above named rnaterial Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or btte 22 of"Cailtorrlta code of regulations has been property <br /> described classr5ed and packaged and is In proper condition for transportation a*cording to applicable <br /> regulations AND,It five waster:a treatment residue of a previously restricted hazardous waste <br /> I suubject to the Land Disposal Restrictions I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance wdh the requirements of 40 CFA Part 268 and Is no"or a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WNSTA TYPE <br /> I <br /> DISPOSAL U SLUDGE <br /> ❑ QNSTRUCTION ❑WOOD <br /> 0 DEBRIS ©OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 wet sonatina St. sTOQCPaN <br /> TRANSPORTER NOTES VE�HIJCLE LICENSE NUMBER TRUCK NUMBER <br /> Tharp Off C&I ADDRESS yr14 <br /> 351 <br /> CITY,STATE,ZIP <br /> IPHONE END DUMP BOTTOM DUMP TRANSFER <br /> 144 368175 ❑ ❑ —9— <br /> SIGNATURE <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVERDATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> I ❑ ❑ ❑ Ell* L l— <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> I 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 /> 0 SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGE DATEJ <br /> 0 WOOD <br /> ASH <br /> `k U SPECIALOTHER <br /> SCHEDULING MAST BE MADE PRIORT03.00 P.M.THE DAY PRIORTO EXPECTED ARRIVALeANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> p1DAY <br /> r.BfE]FOORE <br />