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❑ Keller Canyon <br />Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />❑ Ox Mountain <br />❑ Newby Island <br />itary Landfill <br />Sanitary idfill <br />12110 San Mateo Road <br />1601 Dixon Landing Road <br />Half Moon Bay, CA 94019 <br />Milpitas, CA 95035 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Fax (650) 726-9183 <br />Fax (408) 262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />❑ Forward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERATOR <br />WASTE ACCEPTANCE NO. <br />MAILING ADDRESS <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />11GLOVES O 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 />P- <br />GENERATOR's CERTIFICATION: I hereby certify that the above named material is not a hazardous <br />waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations, has been property <br />described, classified and packaged, and is in proper condition for transportation a^cording to applicable <br />regulations; AND, If the waste Is a treatment residue of ■ previously restricted hazardous waste <br />subject to the Land Disposal Restrictions, I certify and warrant that the waste has been treated in <br />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 />RECEIVING FACILITY <br />r <br />WASTE TYPE: <br />O DISPOSAL ❑ SLUDGE <br />❑ CONSTRUCTION ❑ WOOD <br />❑ DEBRIS ❑ OTHER <br />❑ SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: <br />VEHICLE LICENSE NUMBER TRUCK NUMBER <br />ADDRESS <br />CITY, STATE, ZIP <br />l .:4 <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER <br />DATE <br />ROLL-OFF(S) FLAT-BED VAN DRUMS <br />❑ ❑ ❑ ❑ <br />I hereby certify that the above named material has been <br />accepted and to the best of my knowledge the foregoing <br />Is true and accurate. <br />CUBIC YARDS <br />DISPOSAL METHOD: (Tb BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑ SOIL <br />REMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />❑ NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT <br />DATE <br />❑ WOOD <br />❑ ASH <br />❑ SPECIAL OTHER <br />SCHEDULING MUST BE MADE PRIORT0.3:00 P.M.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 />GENERATOR COPY MANIFEST 8 <br />