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D Keller Canyon a ❑Coffin Butte ❑Ox Mountain ❑ Newby Island IM Forward <br /> ;f,,,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.Austln Road <br /> €: Pittsburg,CA 94565 Corvallis, OR 97,330 Half Moon Say, CA 94019 Milpitas,CA 95035 Manteca; CA 95336 <br /> i Phone(925)458-9800 Phone(541)745-2018 Phone(650),726-181`9 Phone(408)945-2800 Phone(209)982-4298 <br /> F Fax(925).458-9891 Fax(541)745.3826 Fax(650)726-9183 Fax(408)262-2871 Fax x(209)982-1009 <br /> NON-HAZARDOUS-WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Heft ager Renatt> <br /> MAILING ADDRESS <br /> ,cn Kve <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> - S GLOVES .❑GOGGLES ❑RESPIRATOR )bHARD HAT <br /> PHONE <br /> 209 469-0625 O TY VEK C3 SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> UNMOOR'S CERTIFICATION:I hereby certlfy that the above named material Is not a hazardous <br /> l waste as defined by 40 CFR Part 261 or tide 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-.cording to applicable <br /> repulailom;AND,it the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated In. RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pert 26B and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> -IUDISPOSAL O SLUDGE <br /> C]CONSTRUCTION C3 WOOD <br /> Q DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.Razeltoti Ave <br /> TRANSPORTER NOTES: VEHICLE LICENSE_ NUMBER TRUCK NUMBER <br /> ><v es- <br /> ADDRESS <br /> 2710 Lownis Rmd <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSF R <br /> (209)45{-1145 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED <br /> VAN. DR $ <br /> � <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 <br /> Is true and accurate. DISPOSAL METHOD; (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE . OTHER <br /> REMARKS <br /> t]SOIL <br /> ❑CONSTRUCTION <br /> FACILITY ICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNAT09E Ok AUTHORIZED AGENT DATE <br /> UWOOD <br /> U. ASH <br /> U 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 /> GENERATOR CORY MANIFEST# 564902 <br /> 9j(y' <br />