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Nw., .. <br /> ❑Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island 9 Forward <br /> Sanitary Landfil: Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coifs Butte Road 12310 San Mateo Road 1601 Dixon Larding Road 9999 S.Austin Road <br /> Pittsburg,CA 94.565 Corvallis,OR 97330 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Plane(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fast(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> n m <br /> MAILING ADDRESial <br /> ex 1\ — 5)5 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ) � ` <br /> PHONE LOVES O GOGGLES O RESPIRATOR -UHARD HAT <br /> 1t- L, - O TY--VEK J5-SAFETY VEST <br /> CONTACT PERSON <br /> era - SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE L ( DATE <br /> GENEM'fdRtfCER`TIPrAi Fwoby owey Nat Me above named real"I is sol a Mzardous <br /> waste as debrwd by ae CFR Pad 261 a,flee 22 of the CaliMnia coae d negotiations,has been properly <br /> described,dassilied and packaged,aro is in proper,condition to lransponabon acarding to applicable <br /> nggWtlans-A <br /> ND,H tlw wW Is•MubMrH ra4dus M s pravbusy nebkted Msndeua wae4 <br /> stairs b IM Land OiePo9el ResfMims.I ceniy are winners Mat Me waste has been heath in RECEIVING FACILITY <br /> eaadanca were the rsrnemanta d 40 GFR PM 2W and is.lager a Iwzrdoes waste as defined W <br /> 40 CFR Pad ati <br /> WASTETYPE: I--'rvnv-r'^ <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION ffa WOOD <br /> O DEBRIS $.OTHER <br /> 0 SPECIAL WASTE S O1 (_ a <br /> GENERATING FACILITY <br /> 1t? A.,r N <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> a r7� rasa 7�t �� 05L�5 <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE - END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS 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: (RD BE COLLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER - DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF,AUTHORIZEpAGENT DA <br /> OWOOD <br /> O ASH _. <br /> ---- O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRNAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> CiENFRATnR CnPY MANIFEST If I 3 I}L <br />