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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island []j Forward <br /> b r $anitary Landfill -Sanitary Landfill "' Sanitary Landfill Landfill <br /> 901, iley F}oad 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 /> r, <br /> MAILING ADDRESS 4 115400 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE UGLOVES O GOGGLES ❑ RESPIRATOR 3,HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON _ SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> �47 <br /> Gt=�iO"tE FICATION I hereby certify that the above named material,s not a hazardous <br /> waste as defined by 40 CFR Pari 261 or title 22 of the California code o'regulations has been properly <br /> described classified and packaged and is in proper condition for transportat:on alcording ie applicable <br /> regulations AND,It 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 has been treated in RECEIVING FACILITY <br /> accordance w:th the requirements of 46 CFA Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> •DEBRIS ❑OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS O <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM HUMP TRANSFER <br /> ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> REMARKS Q SOIL <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR IZECrAGENT DATE <br /> ❑ WOOD <br /> ------------ ❑ ASH <br /> Q SPECIAL OTHER <br /> 411=1112511191= I ., <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHF-RULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> S/-LES COP ' MANIFEST# 65885 <br />