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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 26972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Corvallis,OR 97330 Hall Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2016 Plane(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-AM Fax(650)726-9163 Fax(408)262-2871 Fax(209)962-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> ti.,., -. <br /> MAILING ADDRESS _ 1, 'F <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE EI GLOVES •GOGGLES •RESPIRATOR `•HARD HAT <br /> '168.3060 O TY-VEK •SAFETY VEST <br /> CONTACT PERSON <br /> Jaime Perez SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:1 Ireretiy"edify Iwo"above naa,wl material is not a mooin wre <br /> wade as de noorl by 40 GFR Part Mt or titte 22 of I"California code of requlalWns,lids peen Iron niq <br /> _described,classllied arW pacorap d,and is in proper condition log transportation a'cordirg to applicaMo <br /> mpulmions:AND,If lbe waste le a Irealmanl reeldus of s prevlwsty rMrlcled hez"ous waste <br /> 9Yb'd 1.Ne=Disposal RB9lrkliona,IlrWy aM warrant Riot Piro w851e bag been trained In RECEIVING FACILITY <br /> e iftn ca won tiro requiremenN of 40 CFR Pert 268 aro u no longer a pazardoos waste es defined by <br /> Q CFR Ped 261. <br /> WASTE TYPE: f 1" ' <br /> •DISPOSAL •SLUDGE <br /> •CONSTRUCTION O WOODry. N fy-C <br /> •DEBRIS •OTHER hcr)-r 74? <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> . SU.i_ V1D1 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ��7'IU;J�I� 335J <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 hereby certify that the above named material has been V f�J a <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE GOMPL D BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS •SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> •WOOD <br /> ❑ASH <br /> •SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRMAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST Nf J 6 2 /I <br />