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Ll Keller Canyon o [:]Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward . <br /> J. .Sanitaey Landfill Landfill Sanitary Landfill Sanitary Landfill. Landfill <br /> I4 901 Bailey Road 28972 Coffin Butte Road- 110110 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> II Pittsburg,CA 94565 Corvallis, OR 97330" Half Moon Bay, CA 94019 Milpitas CA 96035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(498S 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 WASTEMANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hea fittr Kt acK rx" <br /> MAILING ADDRESS <br /> ve — <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> UtoddMa 95203. <br /> PHONE r <br /> 4 GLOVES ❑GOGGLES a RESPIRATOR : AO HARD HAT <br /> 469-IX2S ❑TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> g,rdt_G SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S UhTIFICATIDN:I hereby certify that the above named material Is not'A hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is In proper condition for transportation ahording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previcusty resMcted haxsrdous waste <br /> subject to the Land Dlspcsat Restrictions,I certify and warrant that The waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements'of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pati 261. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE ' <br /> GENERATING FACILITY <br /> ZOOS W:H=Itun Ave OCF."IG i <br /> TRANSPORTER NOTES:' VEHICLE LICENSE NUMBER TRUCK NUMBER:''-- ; . <br /> W'Tnitr&er <br /> ADDRESS 27 10 Lpg"v Roadt <br /> CITY,STATE,ZIP <br /> St a-kCA 95205 <br /> PHONE END DUMP BOTTOM DUMP TR N5 R <br /> Z 45&1145 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED-- VAN DRUMS <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and.to the beat of my knowledge the foregoing DISPOSAL METHOD: (To BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DJSPOSE OTHER <br /> EMA KS O SOIL <br /> U CONSTRUCTION <br /> FAC ITY TICKETNUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNA, RE E AUT ORIZ D AGENT DATE <br /> Ij WOOD <br /> ❑ASH <br /> ` ©SPECIAL OTHER <br /> 5 <br /> SCHEDULING MUST BE MADE PRIOR TO 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 /> o <br /> 0ENERATO114 COPY-. MANIFEST,# 4 <br /> .9 <br />