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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 />C 'tary Landfill <br />1 ,10 San Mateo Road <br />Half Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />❑ Newby Island <br />Sanitary idfill <br />1601 Dixon Lal iding Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <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 PERSONALuPROTECTIVE EQUIPMENT <br />D GLOVES U GOGGLES ❑ RESPIRATOR U HARD HAT <br />❑ TY-VEK ❑ OTHER <br />PHONE <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />-3 <br />SIGNATURE OF AUTHORIZED AGENT / TITLE <br />DATE <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 Califomia 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 s 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 Part261. <br />RECEIVING FACILITY <br />WASTE TYPE: <br />D DISPOSAL 0 SLUDGE <br />O CONSTRUCTION ❑ WOOD <br />❑ DEBRIS ❑ OTHER <br />❑ SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER. - <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />ADDRESS) <br />" <br />CITY, STATE, ZIP <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER <br />DATE <br />ROLL -OFFS) FLAT-BED VAN DRUMS <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: (Td BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />SOIL <br />❑ <br />EMARKS <br />0 CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />❑ NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT <br />DATE <br />❑ WOOD <br />❑ ASH <br />0 SPECIAL OTHER <br />SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL o ANY UNSCHEDULED LOADS ARE SUBJECT <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />MANIFEST M <br />