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❑Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island Worward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Corvallis,OR 97330 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)468-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GEERATOR WASTE ACCEPTANCE NO. <br /> l <br /> MAILING ADDRESS _ CJ <br /> r <br /> CITY,STATE,ZIP REQUIRED PERSONAL PRUIFECTIVE EQUIPMENT <br /> ❑GLOVES ]GOGGLES ❑RESPIRATOR >fHARD HAT <br /> PHONE <br /> QTY—VEK *_SAFETY VEST <br /> CONTACT PE SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED A NT/TITLE DATE <br /> 0hov, ��t D` 0q,1/1 <br /> GENERATOR'S RTI TIO :I Money potiry mal nu shove namee nnlerul e'. a haaarepus <br /> waste as eNnbe d0 R PaR 261 or We 22 of me Calibrnte cone of regdahons,has been property <br /> esacraee,dassAiee are pa xagee,and is n pope contlean for uanspaRalbn a corning Io applcao <br /> rapYMgv;AND,It me waste Is a IraM1a d rasl#pe M a on imshy nslrIeW Iteertlous waste <br /> sWpel Is IFe lane Diapoaal Raeaklions I nNp snot wanan that the waste has hear Inalne on RECEIVING FACILITY <br /> aOCp(OIaCa wi1M ma raryanmanln d<0 GFR Part 268 arM 6 holongar a M83are0us wade as ne1nM py <br /> 40 cRR PN 261. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION J WOOD <br /> O DEBRIS ILOTHER �p. <br /> O SPECIAL WASTE <br /> GENERATING FACILITYh-1 rwarooi— W1 ' ' <br /> A <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 7 _ J`— <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 hlsreby certify that the above named material has been <br /> acceloted and to the beat of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> a <br /> REMARKS SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNA RE,OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> ❑ASH <br /> i - — – <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3"00 P.M.THE DAY PRKMTO 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 /> ",ENFG^:Tr'! MANIFEST# 7 3 8 713 <br />