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❑ Keiler Canyon ❑ Qx Mountain ❑ Newby Island rd Sanitary Landfill Sanitary LandfifI Sanitary Landfill Fo[Agirward 901 Bailey Road "` 120 San Mateo Road -- 1601 Dixon Landing Road 9999 S Austin Road Pittsburg, CA 94565 tW Half Moon Bay, CA 94019 Y Milpitas, CA 95035 Manteca, CA 95336 Phone (925)458-9800 Phone(650)726-1819 Phone (408) 945-2800 Phone (209)982-421 Fax(925) 456-9891 FaxJ650) 726-9183 Fax (408)262-2871 Fax(209)982-1 f NON=HAZARDOUS WASTE MANIFEST GENERATOR Z WASTE ACCEPTANCE NO. MAILING ADDRESS,, r.;, CITY, STATE, ZlP 1 '--„ REQUIRED PERSONAL PROTECTIVE EQUIPMENT PHONE a GLOVES U GOGGLES a RESPIRATOR O HARD HAT CONTACT PERSON r $ i 1� i a TY-VEK ❑OTHER 0� SIGNATURE OF AUTHORIZED AGENT!TITLE DATE �». J GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or title 22 o1 the California code of regulations has been property described Classlfied and packaged and is in proper condition for transportalron a-cording to applicable regulations AND It the waste is a treatment reefdus of a Prevleuety Matrfcted hazardous waste subluct to the land Disposal Restrictions I certify and warrant that the waste hau been treated in accordance with the requirements of 40 CFR Part 2618 and is no longar a hazardous waste as defined by RECEIVING FACILITY 40 CFR Part 261 WASTE TYPE ❑ DISPOSAL U SLUDGE a CONSTRUCTION a WOOD U DEBRIS rte diER U SPECIAL WASTE GEN -RATING �FAC�ILLIITy �� TRANSPORTER, NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER ADDRESS .r - -�� END DUMP BOTTOM DUMP TRANSFER SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE� T _ _ __ _ �__ T ❑ `T T -_- - -� � s s ROLL-OFFS FLAT-BED VAN DRUMS 312 CUBIC YARDS ' I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing - - -Is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) DISPOSE OTHER EMARKS a SOIL ' ©CONSTRUCTION FACILITY TICKET NUMBER DEBRIS D NON-FRIABLE SIGNATURE OF-AUTHORIZED UTHORIZED AGENT ASBESTOS a woos o ASH ❑SPECIAL OTHER SCHEDULING MUST BE MAIE PRIORTO 3.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBfEGT TO REFUSAL UPON ARRIV --ON60ING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE MANIFEST# A-14 A r, 4;