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' ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill s Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Barley 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 /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ID GLOVES U GOGGLES 0 RESPIRATOR -tiU HARD HAT <br />' f ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> g a SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br />' GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California Code of regulations has been properly <br /> described ciassdied and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND If the waste ie a treatment residua of a previously restricted hazardous waste <br /> $"bled to the Land Disposal Restrictions I certify and warrant that the waste has been treated", RECEIVING FACILITY <br />' accordance with the requirements of 40 CFR Part 268 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 />' Q DEBRIS O 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 /> ❑ ❑ ❑ <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 <br /> Iis true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITYTICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ❑WOOD <br /> I ❑ 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 /> fMANIFEST# ¢' J <br /> SALES COPY <br />