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❑ Koller Canyon. ❑ Ox Mountain ❑ Newby Island ] Forward ' <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill -landfill <br /> "901 Bailey Road 12310 San Mateo Road 1601 Dixon Landjng Road 9999 S Austin Road <br /> ,*,Pittsburg, CA 94565 Half Moon Say, CA 94019 Milpitas, CA 95035 Manteca,CA 9533-6- <br /> Phone <br /> 5336Phone (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 f WASTE ACCEPTANCE;NO. <br /> MAILING ADDRESS a <br /> CITY,STATE,ZIP ' 1 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES ❑GOGGLES G RESPIRATOR Q HARD HAT <br /> ©TY VEK ❑OTHER <br /> CONTACT PERSON ,, i,', J SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFA THORIZEDAGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby cartdy that the above named malarial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or bile 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,it the waste is a treatment residue of a previousty 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 L1 SLUDGE <br /> L]CONSTRUCTION 0 WOOD <br /> •DEBRIS `- OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER f� , ; NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY-STATE,ZIP—S- 7: � - ,1 -d - --I <br /> END DUMP BOTTOM DUMPY TRANSFER <br /> ❑ ❑ --- <br /> SIG UTHORIZED AG NT ORARIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * s ✓ � ', r ter <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my Knowledge the foregoin <br /> Is true and accurate g DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS Y <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZIEVAGENT ATE <br /> G WOOD <br /> O ASH <br /> _ <br /> Q S EGEAL OTHER <br /> S,CHEDULING MUST BE MADE PRIORTO 3 00 P.M THE DAY PRIORTO EXPEoIrED ARRIVAL a ANY UNSCHEDULED LOADS ARE SE1BJlE <br /> TO REFUSAL. UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED NINTH THE LANDFILL THE DAY' BF_FOl9� <br /> MANIFEST# 43490 <br />