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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 /> 40 Fax(925)458-9891 Fax(650) 726-9183 Fax (408) 262-2871 Fax(209) 982-1009 <br /> \ NON-HAZARDOUS WASTE MANIFEST <br /> 5 <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> _=x-LTD r <br /> MAILING ADDRESS <br /> Zavu <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I"=lottt'"iT=287` Z1 GLOVES Q GOGGLES a RESPIRATOR !Q HARD HAT <br /> PHONE <br /> 0-A ; QTYVEK ©OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> qL <br /> GENERATOR S QERTfFICATI0N l hereby certrty that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Camomra code of regulations has been properly <br /> described classified andpackaged and is in proper condition for transportation a-cording to 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 with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261 <br /> WASTE TYPE <br /> @ DISPOSAL O SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> Q DEBRIS ID OTHER <br /> Q SPECIAL WASTE <br /> ENERATING FACILITY <br /> X00;haw:kua S"_"0�?'s'�?*V <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBED TRUCK NUMBER, <br /> ADDRESS <br /> 19555 N TU1117 R021d <br /> CITY, STATE, ZIP <br /> Lodiref&Q-CA 9 z3"a <br /> PHONE J END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFeAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ' ❑ ❑ ❑ ❑ <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 /> Q SOIL <br /> EMARKS <br /> ❑ CONSTRUCTION <br /> r° �! DEBRIS <br /> FACILITY TICKET NUMBERA O NON-FRIABLE <br /> P / , ASBESTOS <br /> IGNATURE OF AUTHORIZED AGENT- DATE <br /> r r e r.tT^i^P r f ❑WOOD <br /> Q ASH <br /> * Q 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 13EFORE <br /> MANIFEST# 2 — <br /> GcNEF�TOf�COPY � S 16 <br />