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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> r Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg, CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone (925)456-9800 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 982-4298 <br /> Fax(925)458.9891 Fax(650) 726-9183 ` Fax (408)262-2871 Fax (209) 982-1009 <br /> • <br /> NON-HAZARDOUS WASTE MANIFEST <br /> [CONTACT <br /> ERATOR WASTE ACCEPTANCE NO. <br /> ING ADDRESS 94 09 <br /> , STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I O-GLOVES I GOGGLES ❑ RESPIRATOR 0 HARD HAT <br /> NE <br /> p TYVEK ❑ OTHER <br /> PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZE GENT/TITLE DATE <br /> 'die Et3A7OR yCsERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as o.f", by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transponat on a-co ding 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 certify and warrant that the waste rias been treEL60 in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL a SLUDGE <br /> ❑CONSTRUCTION D WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Q <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I 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 /> ❑ SOIL - <br /> PEMARKS <br /> ❑ CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ WOOD <br /> ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> G'LES -CPY MANIFEST# 3 a 8 61 <br />