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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward I Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road IPittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 Phone(925)458-9800 Phone(OW)726-1819 Phone(408)945-2800 Phone(209) 982-4298 Fax(925)458-9891 Fax(650 726-9183 Fax(408)262-2871 Fax(209)982-1009 NON-HAZARDOUS WASTE MANIFEST GENERATOQ A WASTE ACCEPTANCE NO. MAILING ADDRESS _ 25 7 CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT 75-T-05C_PGW CIA ❑GLOVES O GOGGLES ❑RESPIRATOR U HARD HAT PHONE ❑TY VEK ❑OTHER CONTA T PERSjON A SPECIAL HANDLING PROCEDURES I SIGNATURE OF AUTHORIZED AG I TITLE DATE 119-1A I GENERATOR'S CEF(MCAT" I hereby owefy that the above named md*ntd is not n hazardous waste as defined by 40 CFR Pan 261 or tine 22 or thus CaRtomie code of rayufa No s,tms been properly desrnbed,danadiod and packaged,and is In proper candlhon for ttanapartadon*Omding to sppyicable regulatkxes ANq M 4ue waste is a veemferd reafdue of a previously restrtoted hazardous%sate subject to the Eared Disposal Restneliorn I ceruty and warrent drat the waste has been treated In RECEIVING FACILITY =wdanca wdh the requimumMs ora CFR Part 26E and is no longer a hazardous waste as defined by 40 CFR Pan 261 WASTE TYPE ,XPISPOSAL ❑SLUDGE I ❑CONSTRUCTION ❑WOOD ❑DEBRIS ❑OTHER U SPECIAL WASTE GENERATING FACILITY TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER IADDRESS � r CITY, TATE,ZIP + - PHONE END MP BOTTOM DUMP TRANSFER ❑ ❑ SIGNATURE 0"U A NT OR DRIVER DATE ROLLFF S) FLAT-BED VAN DRUMS U Ll L3 ' CUBIC YARDS I hereby certify that the above named material has been I accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) Is true and accurate. DISPOSE OTHER I O SOIL REMARKS O CONSTRUCTION FACILITY TICKET NUMBER DEBRIS ONON-FRIABLE ASBESTOS SIGNATURE OF A R D T JATE ❑WOOD ❑ASH � SPECIAL OTHER SCHEDULING MUST BE MADE PRIORTO3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. MANIFEST i 7 Q Q Q 9;