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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 Haff 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)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> f t^tui=t <br /> ORleemc WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> e e4 Mail Stop B24 A 431-4 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> sin <br /> PHONE O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> (415.)9734-377,31 O TY-VEK O OTHER <br /> CONTACT PERSON <br /> Robert G-av SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZ p AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION;I hereby certify that the above named materiar is not a hazardous <br /> waste as defined by 40 CFR Part 261 or fide 22 of the California code of regulations,has been property <br /> X, described,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> regulations;AND,If 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 <br /> t accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> -„ 40CFR-Part 261. <br /> WASTE TYPE: <br /> 1SPOSAL O SLUDGE <br /> OSTRUCTION O WOOD <br /> O DCRIS O OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> Dehy&rator rte. L,Al--ROP <br /> Qr `fER NOTES: VEHICLE LICENSE NUMBER TRUCK IVIBER <br /> ESS <br /> �- <br /> z ATE,ZIP <br /> ,CA 9549 ? - <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707):M-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> O <br /> REMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> ,SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# n n n n .9 r <br />