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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Salley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Say,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Y 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 N0, <br />' <br /> MA(LfNr3 hDMAESS <br /> CITY TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPTENT" <br /> C]GLOVES 0 GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHUW <br /> fl TY VEK ❑OTHER <br /> CONT T PER ON I , A SPECIAL HANDLING PROCEDURES <br />' SIGNA I URE OF AUTHORIZED AG /TITLE DATE <br /> GENERATOR'S CERTIFICATION.l hereby above nerved materiel is not a hazardous <br /> waste as definsd by 40 CFR Pad 261 or Idle 22 of do Caldor coda of repuiations,has been pmpedy <br /> described,classified and peckaped,and is In proper oondWO for tranaporfafioa&-=din0 to appkmble <br /> regulatims AN0.It the waofft Is s NMhnent residue of a previously rsstriehd hazwdoua wearo <br /> StOluct to ma Lard DWposal Rasbicbons I corky and warrant that the waste has been treated in RECEIVING FACILITY <br /> ac=darce wdh the fecimmmonts of 40 CFR Part 268 and Is no!Dopar a hazardous waste as defined by <br /> 40 CFR Part 281 <br /> WAST TYPE <br /> ISPOSAL C1 SLUDGE <br />' 45 CONSTRUCTION a WOOD <br /> 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANS RTERNOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> .L 5P' k 7 e 4T �- <br /> ADDRESS <br /> CITY,STATE, <br /> PHO E END DUMP BOTTOM DUMP TRANSFER <br /> Ll L1 U <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS "T-BED VAN DRUMS <br /> 462 <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 /> I U SOIL <br /> EMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> O ASH <br /> 0 SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIOR 3:40 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARF-SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST 0 9 R Q 7 A <br />