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❑Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island ®Forward <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)458-9891 Fax(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 /> MAILING ADDRESS <br /> y J. <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a 'vif` `-' - LOVES O GOGGLES U RESPIRATOR a HARD HAT <br /> PHONE <br /> U TY-VEK Z SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF THORIZ_ED AGENT/TITLE DATE <br /> GENERATO R FICATION:I bareby,coney Mal IM above named material is not a bivan0ws <br /> wash,u deMM by 40 CFR Pan 261 w Iola 22 of IN California cMe d regWabons,bas Men plop" <br /> desonhod,clasailiM and pack ,and is in proper concision Id lransponMkn a'con*;,,b alpacatfw.. <br /> regNaeons;AMd". <br /> p,If tM wyyle •bM,1Mn,I npldW of•Ma,nlaealy nabkh,d Maardoua araab <br /> swpd In IM lend pispmar 1lcskm.I[Miry ano warm anal IN wase on;hien IbnN,,in RECEIVING FACILITY <br /> a¢ordanca Winn no raenJiNne d 40 CFR Pan 268 and 19 An longer a ling does waists as daened by ` <br /> 40 CFR Pan 26t. ` <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION J WOOD <br /> O DEBRIS 2511 OTHER 5o i <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> `"I <br /> TRANSPORTER Mill- NOTE VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 9 -� b 1 O <br /> CITY,STATE,ZIP <br /> PHONE Y END DUMP BOTTOM D MP TRANSFER <br /> L) IQO . <br /> SIGNATURE OF AUTHORIZ ED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 0 ❑ <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; (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS <br /> O SOIL ,. <br /> h, U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE'OFAUTHORIZEDAGENT DATE <br /> U WOOD <br /> O ASH <br /> I <br /> " U SPECIAL OTHER <br /> SCM - UNG 'lr- PiWW103-MP.M.IM TO EXPECTED ARRIVAL-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 I - MANIFEST 0 '718912 <br />