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❑Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island El Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Corin 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)7454018 Phone(650)726-1819 Phone(406)945-2800 Phone(209)962-4298 <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 /> RwJ <br /> MAILING ADDRESS _ 688 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> fl GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE__ <br /> ub ' ❑TY-VEK )U SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE <br /> TOH'8 CERTIFICATION:I hareCy caddy Oat the abate named mte <br /> arial is rot a Ma thdooa <br /> u 4BIMIBd 01'40 CFR Pad 261 or Ilde 22 of me calilotnia code of ragulata 'has Ceara faopaly <br /> dacWed,WaW,datl pacheped,andfab Proper co rionlahanapodshona-cooh,gtoapplicable <br /> raptlatlpq AND,Nate a frta N a lrsaimant raaldua of a previously restricted hazardous waste <br /> sublecl a 6a utod OkPosel Restrictions,I wrory aM wanam that the waste has baso aeatedm RECEIVING FACILITY <br /> eccordattca vdth 4o rapuiremetaa of 40 CFR Pad M anct M.brger a hazarcbus Waste as defasd M <br /> 40 CFR Pad 261. ? <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> p CONSTRUCTION U WOOD <br /> O DEBRIS D OTHER - <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2099 <br /> IGNATUREOFAUTHORIZEDAGENTORDRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> a ❑ ❑ ❑ <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 /> 6§OIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUREOF AUTHORIZED AGENT DATE <br /> •WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> BE COPY MANIFEST X y '? 5 <br />