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❑Keller Canyon q gffin Butte E]Ox Mountain El Newby Island 91 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)745-3626 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 /> CITY,STATE,ZIP 1^ REQUIRED PERS NAL PROTECTIVE EQUIPMENT <br /> LOVES O GOGGLES U RESPIRATOR IO:HARD HAT <br /> PHONE <br /> 1'j — , 1' UTY--VEK .®-SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> tril1V9 <br /> GENEfUTOR' GER CATION r hereby unity mal me above namee mmariar is not a Iwardoas <br /> g <br /> • ale ae M.1 by 40 CFR Pan MI or rill.22.1 r1R Cdribmia coca W regWargM,nae then plow, <br /> eeecaiee,daisidied a,[p.cka,id.ane ism proper common for lransponauon a coming u,applkable <br /> rogteek^s <br /> . ,AND,If ate..1.Is s Inelmenl rnlEtM W.Waalousl, Ml tW mtsind a.. <br /> aaeledm me and Disposal Restwaona l caddy ala werrannhauhe was,.has best,b.arod in RECEIVING FACILITY <br /> emmEerxx w,m tM regua,.esnls pl a0 CFR Pan 2138 nb is no longer a hazardous waste as delinae by <br /> Q CFR Pan MI <br /> WASTE TYPE: —oa wv,��-• I v�. : , <br /> O DISPOSAL ]SLUDGE <br /> ❑CONSTRUCTION 7 WOOD <br /> U DEBRIS %LOTHER,.0. <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> r 104 , <br /> TRAIJSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> t �l 'ST • <br /> CITY,STATE,ZIP <br /> PHONEEND DUMP BOTTOM DUMP TRANSFER <br /> _ <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 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> o SOIL <br /> MARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> _ ASBESTOS <br /> SIGNATORE9F AUTHORIZED AGENT DATE <br /> i I 1 U WOOD <br /> I , � <br /> D ASH <br /> � 1 <br /> 13SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO 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 /> .,ENERATOR COPY MANIFEST k 71 PI9 L 0 <br />