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❑ Keiser Canyon - ❑ Ox Mountain ❑ Newby Island Z] Forward Sanitary Landfiil=� Sdnitary Landfill Sanitary Landfill -Landfill 901 Bailey'Fload i 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road PittburT,"LA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 ' Phone (925)458-9800 Phone(650) 725-1819 Phone (408) 945-2800 Phone(209)982-4298 Fax (925)458-9891 Faz (650) 726-9183 Fax(408) 262-2871 Fax (209) 982-1009 NON-HAZARDOUS WASTE MANIFEST GENERATORr WASTE ACCEPTANCE NO. , , , MAILING ADDRESS LL CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT PHONE U GLOVES a GOGGLES ❑RESPIRATOR ❑HARD HAT U TY-VEK O OTHER CONTACT PERSON L7 w F f -, SPECIAL HANDLING PROCEDURES SIGNATURE OF AUTHORIZED AGENT/TITLE DATE rr� GENEi3ATOR S CERTIFICATION I hereby cenity that the above named matenal is not a hazardous wasta as defined by 4D CFR Part 261 or fdle 22 of the Cahfomua code of regulations has been property described lass W and packaged and to to proper corkhtion for transportation a-cording to applicable regulations AND,It the waste in a treatment residue,of a prewlousty restricted hazardous waste subiecl to the Land Disposal Restrictions I certify and warrant that the waste has been treated In RECEIVING FACILITY accordance with the requirements of 40 CFR Past 268 and is no longer a hazardous waste as defined by 4p CFR Part 261 WASTE TYPE ❑DISPOSAL ❑SLUDGE :M1 ❑CONSTRUCTION Q WOOD D DEBRIS G]ETHER q SPECIAL WASTE a GENERATkNG FACILITY s RANSPORTER r „ , , / y NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER jl ADDRESS Ul J r 1 elf ^� ^7 r r-+ - l CITY,STATE,ZIP • , � 4 ! ' , PHONE ,r _ _ > END DUMP BOTTOM DUMP TRANSFER SIGNATURE OF AUTHORIZtp AGENT OR DRIVER DATE ROLL-OFF 5 FLAT-BED VAN DRUMS 4 .t d r l E r 1 e " t F CUBIC YARDS hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) Is true and accurate DISPOSt_ ' OTHER EMARKS U SOIL U CONSTRUCTION FACILITY TICKET NUMBER DEBRIS Q NON-FRIABLE ASBESTOS SIGNATURE OF AUTMOFi1ZED AGENT DATE r ❑WOOD O ASH i Ll SPECIAL OTHER HEDULING MUST BE FADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED,ARRIVAL O ANY UNSCHEDULED LOADS ARE SUBJECT O REFUSAL. UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE O MANIFEST# 434086 rr,..s nn,r.n•..-.�..r.r,,.