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❑Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island F1 Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Matte 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)962-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726.9183 Fax(40B)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES O GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE <br /> QTY-VLIC b SAFETY VEST <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE :ID,ATE <br /> - I <br /> f <br /> GEN9WORS CE"FICATION:I IlweW d"ily flier IN above named mdedal a rwl a aa]adOYa <br /> ­w as defined by Q CFR PN 261 ar N N ni Ibe Calitomia code W re"iiIxx,nes been Prapely <br /> deepr .rJasaiiw end peclap mt Md re F Proper condition for eer appWon a-m ding to W[InFIde <br /> repWafinln:AND,N ere Walt Ya tlesOmanl rani!!"of a pravbaaly rIM1oMd h..MN us wash <br /> Rmlecl b Na lad Disposal Rsbicd ,I certity and warren[tMI ft w lre been Vemed inRECEIVING FACILITY <br /> acCerdale'B w dW re1PNBIlIBllbd M CFR Pm1266 and w m topper a IIHanloue waste m daft by <br /> 40CFR Pan 261. <br /> fG / <br /> WASTE <br /> O DISPOSAL ❑SLUDGE I �I 7 1(.. lin RcaCI l <br /> O CONSTRUCTION O WOOD i i"/,1 J y` n /' /- I li'� y/ <br /> ❑DEBRIS l7 OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> — <br /> Deft. <br /> t. <br /> ADDRESS <br /> II'V <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER JDATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 accyrate. <br /> DISPOSE OTHER <br /> Q SOIL <br /> MARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> a WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M,THE DAY PRIORTO 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 pv J V <br />