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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward Sanitary Landfill f itary Landfill Sanitary idfill Landfill 901 Pailey Road 1 �„ 10 San Mateo Road 1601 Dixon Lauding Road 9999 S. Austin Road Pittsu„,rg, CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 Phone (925) 458-9800 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 982-4298 Fax (925) 458-9891 Fax (650) 726-9183 Fax (408) 262-2871 Fax (209) 982-1009 ,U DISPOSAL U SLUDGE U CONSTRUCTION U WOOD U DEBRIS :1 OTHER \ U SPECIAL WASTE NON -HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. a v MAILING ADDRESS '350 50 CITY, STATE, ZIP_ REQUIRED PERSONAL PROTECTIVE EQUIPMENT U GLOVES 0 GOGGLES U RESPIRATOR U HARD HAT U TY-VEK G OTHER PHONE CONTACT PERSON SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT / TITLE DATE GENERATOR'S CERTIFICATION: I hereby certify that the above na ' material is not a hazardous waste as defined by 40 CFR Part 261 or title 22 of the California code• ?egulations, has been properly described, classified and packaged, and is in proper condition for transportation a -cording to applicable regulations; AND, If the waste Is a treatment residue of a previously res hted hazardous waste subject to the Land Disposal Restrictions, I certify and warrant that the waste Itas been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by 40 CFR Part 261. RECEIVING FACILITY - -'F,,- WASTE TYPE: ,U DISPOSAL U SLUDGE U CONSTRUCTION U WOOD U DEBRIS :1 OTHER \ U SPECIAL WASTE GENERATING FACILITY TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER ADDRESS r CITY, STATE, ZIP PHONE END DUMP BOTTOM DUMP TRANSFER l- ❑ SIGNATURE OF AUTHORIZED AGENT OR DRIVE DATE ROLL-OFF(S) FLAT-BED VAN D UMS I hereby certify that the above med material has been accepted and to the best of my k owledge the foregoing is true and accu te. \ CUBIC YARDS DISPOSAL METH (TO BE COMPLETED BY LANDFILL) DISPOSE OTHER IL REMARKS O CONSTRUCTION DEBRIS FACILITY TICKET_NUMBER U NON -FRIABLE ASBESTOS SIGNATURE OF AUTHORIZED T DATE ❑ WOOD rVI /f ❑ ASH U SPECIAL OTHER S'C`HEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJE TO R.9FUSAL UPON ARRIVAL. ONGOING DAILY LIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEPQ�. ��`` MANIFEST #