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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 Hef Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2016 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4296 <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 /> P <br /> MAILING ADD <br /> - 95 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUI MENT <br /> PHi t r (1 GLOVES ❑GOGGLES O RESPIRATOR yaLHARD HAT <br /> ONE ' <br /> - n Y ❑TY-VEK ¢..SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHOR! ED AGENT/TITLE DATE <br /> cm <br /> GENERATOR'S((E(ITI 1 Ai I hereby iy Mimi—a ,:e budanced ma al is not a hazardous <br /> wane As dalinad 004440 FR Pan al p line 22 d Ilse Celilornia cM d r"g iio ,has assn properly <br /> tlasnEed,daasilied aM packaged,sand is h prove,condition for transportation a'Crord,,to applcabie <br /> legulallons AND.II the wale h•Ir..illten[rest of A weabah asldclad boards..Wat. <br /> aWjara b IM( Disposal Rearidions,I candy and warrant Ilial the Waste ha aean bated in RECEIVING FACILITY <br /> asabodance start Ida reauvamen0 d 40 CFR Pan 200 add is no bnger a haaardotrs waso as dafxwtl by <br /> 40 CFR Pant j <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> O DEBRIS <br /> OTHER 517 <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPO R + NOTES: VFrHICLE LICENSE NUMBER x TRUCK NU ER <br /> CITY,STATE821P <br /> E - END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZED AG NT OR DRIVER DATE ROLL-OFF(S) 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: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> MARKS _ - O SOIL <br /> -- --- ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER - _ - _- - DEBRIS <br /> -- - -- ❑NON-FRIABLE <br /> LRF OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD❑ASH <br /> -- D SPECIAL OTHER <br /> SCHEOULWG MUST BE MADE PRIORTO 3:00 RM.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 a 7'1 ?I 90{� <br />