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1-1 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 Say,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 /> 'an 11!11am, _our:, <br /> MAILING ADDRESS — :bi y�`v <br /> r,s _ , -.o.; ,. ' - <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> O GLOVES O GOGGLES ❑RESPIRATOR `❑HARD HAT <br /> PHONE <br /> _05 i 4o8•30w: O TY-VEK O SAFETY VEST <br /> CONTACT PERSON <br /> anile ere j SPECIAL HANDLING PROCEDURES: <br /> SIGNATURF OF AUTHORIZED AGENT/TITLE JDATE <br /> I*_' Lao - <br /> G TOF9 CEHfIFICATION:I hereby 6w1 ft rmrrbd maredd M rot a wzerdoua <br /> u de@red by 40 CFR Pan 261 m d 22 d d,e(iaMxft onda d rep WO ,Ne�prapedy <br /> weai0ad,doe0nd and peckeped aM Is n proper mnNtipn WtmnyMaWn a' ON bapplkada <br /> ra0ala ;AMD,M tw waM h e treMment ralmre W e previately reMrlclW Mxadow waab <br /> Marled b iw tam Ghpued Rwbcwrn,r cerWy vmnam plat d,e waeta nae wan veered n RECEIVING FACILITY <br /> a dw vmh do meutar M d 40 CFR Pan 286 and 4 no b,gerawzudoua wanb as daared by <br /> M CFR Pan 261. <br /> WASTE TYPE: ��rg6�E !,��'c� �.�'�rl c.�4'' <br /> O DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD �)-) !y,! v r i; �� - <br /> ❑DEBRIS O OTHER y <br /> O SPECIAL WASTE r, 7.yl <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER aaa�TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> ,1.'..- - on,_ . . <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> v: <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ll <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 'i 1 <br /> accepted and to the best of my knowledge the foregoing DISPOSAL M6T4oD: (FO SE COMPIGTLD BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS )SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> CI WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR 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 MANIFEST 9 3623 <br />