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❑ Keller Canyon <br />❑ Ox Mountain <br />❑ Newby Islancl <br />u rorwwu <br />Sanitary Landfill <br />-iitary Landfill <br />Sanitare indfill <br />Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />i 2310 San Mateo Road <br />Half Moon Bay, CA 94019 <br />1601 Dixon mounding Road <br />Milpitas, CA 95035 <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (925) 458-9800 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Fax (408) 262-2871 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />Fax (925) 458-9891 <br />Fax (650) 726-9183 <br />above named material is not a hazardous <br />wasteas defined by 40 CFR Part 261 or fomia code of regulations, has been property <br />described, classified and packaged, and for transportation a^cording to applicable <br />GENERATOR'S CERTIFICATION: I her<Ca12ar% <br />regulations; AND, If the waste Is a tryof • prevlousty restricted hazardous waste <br />subject to the Land Disposal Restrictionwrant that the waste has been treated in <br />accordance with the requirements of 40 is no longer ahazardous waste as defined by <br />40 CFR Part 261. <br />RECEIVING FACILITY <br />NON -HAZARDOUS WASTE MANIFEST <br />WASTE TYPE: <br />GENERATOR <br />`BASTE AC"(4-EP 1ANCE NO. <br />MAILING ADDRESS <br />— <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />❑ GLOVES © GOGGLES ❑ RESPIRATOR ❑ HARD HAT <br />❑ TY-VEK ❑ OTHER <br />PHONE <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT / TITLE <br />DATE <br />above named material is not a hazardous <br />wasteas defined by 40 CFR Part 261 or fomia code of regulations, has been property <br />described, classified and packaged, and for transportation a^cording to applicable <br />GENERATOR'S CERTIFICATION: I her<Ca12ar% <br />regulations; AND, If the waste Is a tryof • prevlousty restricted hazardous waste <br />subject to the Land Disposal Restrictionwrant that the waste has been treated in <br />accordance with the requirements of 40 is no longer ahazardous waste as defined by <br />40 CFR Part 261. <br />RECEIVING FACILITY <br />WASTE TYPE: <br />O DISPOSAL ❑ SLUDGE <br />• CONSTRUCTION WOOD <br />❑ DEBRIS O THER <br />❑ SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: <br />VEHICLE LICENSE NUMBER TRUCK NUMBER <br />i`-7 <br />ADDRESS <br />CITY, STATE, ZIP <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />❑ EJ <br />SIGNATURE OF AUTHORIZED AGENT OR DRIV R DATE <br />ROLL-OFF(S) FLAT-BED VAN DRUMS <br />I <br />d <br />I hereby certify that the above named aterial has been <br />accepted and to the best of my knowle ge the foregoing <br />is true and accurate <br />CUBIC YARDS <br />DISPOSAL METHOD: '(TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />�.k SOIL <br />REMARKS i <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET N MBER <br />U NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OFA THORIZED A NT V <br />DATE <br />Ll WOOD <br />'t. <br />❑ ASH <br />❑ SPECIAL OTHER <br />......�..........`.u..nT eG ■■ a me stoln n 2 tW% o u 'rUC nev cofna"rn FYDECTED <br />ARRIVAL a ANY UNSCHEDULED LOADS <br />ARE SUBJECT <br />*4 nr_1JUL1FVU 11111111 IDG Ie1NIJIG rn.vr.. v .a.w- <br />TO REFUSAL UPON ARRIVAL.. -ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br />MANIFEST # <br />GENERATOR COPY <br />