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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 /> I Pittsburg,CA 94565 _ Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 hone(408)945-2900 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 /> IGENERATOR_ WASTE ACCEPTANCE N0. ' <br /> MAILM ADDR S _ ?� <br /> I CI TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GFISa ❑GLOVES Q GOGGLES D RESPIRATOR ❑HARD HAT <br /> I PHONE <br /> ❑TY VEK O OTHER <br /> CONT CT PE ON SPECIAL HANDLING PROCEDURES <br /> ISIGNATURE OF AUTHORIZED A- TITLE DATE <br /> I GENERATOR'S CERFIFCATim I hereby to above named rnme ai isnit a hazardous <br /> waste m defined by 4o CFR Part 261 or 0"22 d do Cam ma oode d regulations hotbeen pr.,y <br /> described desstSed and packaged,aril Is In proper oondibon for transportation wvord M to appkable <br /> mgulatlons AMR It me waste Is a b.atmrnt reakho of a pwiously resbieted hazardous worts <br /> sutjed to the Land Disposal ResaK:b" I°e"and warrant that the waste hes been Vented in RECEIVING FACILITY <br /> mance with the regrnremerns of 40 CFR Part 268 and is no lo"r a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WAST TYPE <br /> DISPOSAL Q SLUDGE <br /> D CONSTRUCTION Q WOOD <br /> ❑DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> IADDRESS 04 <br /> CI ,STA ZIP <br /> PHONE END 014MP BOTTOM DUMP TRANSFER <br /> r- ❑ El <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLLJOFFIS1 FLAT-BED VAN DRUMS <br /> ❑ ❑ <br /> CUBIC YARDS <br /> 1 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 /> PIE—MARKS ❑SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE �( 0 WOOD <br /> Q ASH <br /> ❑SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIORTO3:00 PM.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST 8E SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFFST A 0 4 0 '777 <br />