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i>�tA❑ Kellet' Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> T� 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) 458-9800 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 /> • NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> �F <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑'GLOVES O GOGGLES ❑RESPIRATOR Q,-HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GE C CATION $hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 GFR Pal 261 or tale 22 of the California code of regulations has been properly <br /> described classified and packaged and is to proper condition for transportation alCording to applicable <br /> regulations AND If the waste is a treatment residue of a previously restricted hazardous waste <br /> subieat to the Land Disposal Restrictions I certify and warrant[hat the waste has been treated m RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and rs no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VE—H-ItCCLLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) 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 /> REMARKS ❑SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ WOOD <br /> 1 <br /> / ff G ASH <br /> " r ` ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> :_A ES CfJr 1 MANIFEST# 35866 <br /> 35866 <br />