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❑ KeJler Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> + Sanitary Landfill Sanitary Landfill A- Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg;CA 94565 a Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phone (925)458-9800 ,,. Phone (650)726-1819 Phone (408) 945-2800 Phone (209)982-4298 <br /> Fax(925) 458-9891 c Fax (650) 726-9183 Fax (408) 262-2871 Fax(209) 982-1009 <br /> • NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> r t 1`, I <br /> MAILING ADDRESS 94,4409 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑'GLOVES U GOGGLES U RESPIRATOR Q HARD HAT <br /> PHONE <br /> 0 TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE <br /> `GEN OR 71F1 ATION I hereby certrty that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pari 261 or title 22 of the Calriornia code of regulatians bas been properly <br /> described classified and packaged and is in proper condition Ior transportatton a cording tc applicable <br /> regulations AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I cerlity and warrant that the waste has been treated inRECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Part 268 and is no longer a hazardous waste as delined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS O OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 1 <br /> C t J A c. <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ _zl�_ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> I <br /> CUBIC YARDS <br /> 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 /> 'a SOIL <br /> FfEMARKS U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE U WOOD <br /> U ASH <br /> ✓l . M U SPECIAL OTHER <br /> .f <br /> SCHEDULING MUST BE MADE PRIORTO 3 OOP 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 /> SALES COPY MANIFEST# 3 5 858 <br />