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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill "Landfill <br /> P01 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 />' GENE T R WASTE ACCEPTANCE N0, <br /> MAILING AD RES <br />' CITY,ST TE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Z— U GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br />' PHONE <br /> ❑TY-VEK O OTHER <br /> k4— <br /> qQAPCT PERSON SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AG 1 TITLE DATE] <br />' GENERATOR'S COMFICATION 1 haabY ON*that the abwm named mswrlai R rwt a hazardous <br /> waste as defined by 40 CFF]Part 261 or title 22 of the Cardorda code d negulaWns has been properly <br /> desaroed,N mftd and packaged and is in proper candt oe for transportation a-oordrg to applicable <br /> regulabo s AND,if the vesats to a veauttert residue of a prarbvsy restricted hazardous waste <br /> subject to the Land Disposal Resuicil" t sandy and warrant that the waste has boon treated in RECEIVING FACILITY <br /> 1 accordance wrih the reqWrernents of 40 CM Pat 266 and us no tongsr a hazardous waste as defined by <br /> 40 CFR Pat 261 <br /> WASTE.TYPE <br /> DISPOSAL O SLUDGE <br /> NSTRUCTION 0 WOOD <br /> 1 0 DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1 tip ' ' <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 7 - <br /> ADDRESS ' <br /> 1 <br /> CITY,STA E,ZIP <br /> a <br /> PHONE EN MP BOTTOM DUMP TRANSFER <br /> n <br /> SIGNATURE OF ORIZED AMENT OR DRIVER DAT LL RO (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 knovAedge the foregoing DISPOSAL METHOD- (TO BE COMPLETED BY LANDFILL) <br />' is true and accurate. <br /> DISPOSE OTHER <br />' -REMARKS D 501E <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br />' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE O WOOD <br />' 1 0 ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM 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# 9 R Q <br /> . --.r.Y.• M1MI <br />