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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island v Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill l Landfill <br /> 901 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 /> Y <br /> Phone(925)458 9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> t " 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 NO. <br /> MAILING ADDRESS { <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 0 GLOVES 0 GOGGLES O RESPIRATOR 0 HARD HAT <br /> J `. PHONE. <br /> =` 0 TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Ya <br /> '`'GENERATOR'S CERTIFICATION:I herty that the above named material is not ahazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Is e.treatment residue of a previously restricted hazardous waste -subject to the Land Disposal-Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> �Y accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> s WASTE TYPE: <br /> ISPOSAL O SLUDGE <br /> - CONSTRUCTION O WOOD <br /> DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> L75dwQp Dehy tvr, ion L A'2"FJR0P <br /> 4 _ <br /> "' R NOTES: VEHICLE LICENSE t�17 x f F GK NUMBEH x_ ) <br /> T ' <br /> s . <br /> 8?tf e Court <br /> _ CITY,STATE,ZIP- <br /> "3 PHONE END DUMP BOTTOM DUMP TRANSFER' <br /> 70718M-140? ❑ _ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE.,. ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> * -/S "d <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 /> O SOIL <br /> EMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> ❑SPECIAL0THER <br /> SCHEDULING MUSTBE MADE PRiORT0300 P:M;THE DAY PRIORTO EXPECTED ARRIVAL•ANY: EDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH Ti1E LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 9 Q Q P,Q1; <br />