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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> 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)45'9-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax (209) 982-1009 <br /> o NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> -3 AA11 <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> F�L"P_�,Vlq 'r'+ 94 r- 7 GLOVES O GOGGLES U RESPIRATOR a HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE 'x Al 1 A_'A 7 '� <br /> GENERATOR S t1urnFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pari 261 or We 22 of the California code of regulations has been property <br /> described classified and packaged,and is in proper condition for transportation axording to applicable <br /> regulations AND,h 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 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 /> O DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY CCO X 4 COX <br /> TRANSPORTS NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OFAUTHORIZED AGyENT 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 /> L)SOIL <br /> MARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> � ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHO I AGENT/ E <br /> a wooD <br /> U ASH <br /> U 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 /> GENERATOR COPYMANIFEST#'.'L 5 0 4 7 9 <br />