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„❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [k Forward <br /> Scinitary Landfill Sanitary Landfill �' Sanitary Landfill Landfill <br /> 901 13alley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Hall MoonB4, CA 94019 Milpitas,CA 95035 J Manteca, CA 95336 <br /> Phone(925)458-9800 Phon94650) 726-1819 Phone (408) 945-2800 1% 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 /> 945400 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> >r <br /> PHONE `GLOVES ❑GOGGLES Q RESPIRATOR W-HARD HAT <br /> D TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE QF AUTHORIZED1AGEl�T/TITLE DATE <br /> GENERATORS CERTIFICATION I heraby certify that the above namea material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transporw,on a-cording tc 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 cerhy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements o1 40 CFR Pan 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> t <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS v �� 77 C_ <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER_ <br /> SIGNATURE OFAUT ORIZED AGENT OR DRIVER DATE ROI L-OFF(S) FLAT-BED VAN DRUMS <br /> J 1 Jac`/ -- _ ❑ ❑ ❑ ❑ <br /> J CUBIC YARDS <br /> 1 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 /> FIEMARKS ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> G WOOD <br /> ❑ ASH <br /> ❑ 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 /> SA'-ES CORY MANIFEST# 35867 <br />