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Keller Canyon Cl Coffin Butte ❑Ox Mountain <br /> unitary.Landfill Landfill ❑Newby Island IN Forward <br /> 901 Bailey Road Sanitary Landfill Sanitary Landfill, landfill <br /> s.., 28972 Coffin Butte Road 12310 San Mateo Road <br /> la,CA M36 <br /> Pittsburg, CA 84585 Corvallis,OR 97330 1601 Dixon Landing Road' 9000 5.Austin Road <br /> Phone(925)458-9800 ``-'Phone(541)745-2018 Phone(650 26-1819 19 Milpitas, CA 95Q35 - <br /> ( ) Phone(408)945-2600 Phone(2 9)982-4298 <br /> Fax(925)458 9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408}262-2871 Fax(209)982-1.009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> HeWASTE ACCEPTANCE N0. . <br /> MAILING ADDRESS <. <br /> >rC <br /> CITY,STATE,ZIP <br /> S€ tt�n,C�,5t5Q REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 5GLOVES Q GOGGLES 0 RESPIRATOR )b HARD HAT <br /> 2 4S9�0625 <br /> CONTACT PERSON Q TY VEK Q SAFETY VEST <br /> Pte'C DWI SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENI:RATBR'g C£RTIFICATI4N: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,hes been property <br /> described,classified and packaged,and is In proper oondition for transportation a-cording to applicable <br /> regulations; LanND,if the walla h e treatment residue of a previously restricted hazardous waste <br /> Subject M thea Lend Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40,CFR Part 26B and is no longer a hazardous waste as defined by: RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> Q CONSTRUCTION D WOOD <br /> O DEBRIS 0 OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W:HamItuii Aqe S£t]C`R'TC)14 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCNKNUMBER <br /> Mr.Trker <br /> ADDRESS ` CA , Q <br /> . x71 tl�G[I11191�U�d <br /> CITY,STATE, <br /> PHONE <br /> (2045[-1143 END DUMP BOTTOM DUMP TR NSFER <br /> SIGNATU OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 141 <br /> 3 ❑ a ❑ <br /> � P <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DlsPosA�Mr;Trroo: (To BE coPL <br /> Is true and accurate. i p'.BY LANDFILL) <br /> DISPOSE OTHER . <br /> REMARKS .,Q SOIL: <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATU E OF AUTHORIZED AGENT ASBESTOS <br /> DATE <br /> r 1 Q WOOD <br /> ❑ASH . <br /> C]SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.*hiE DAY PRIOR TO EXPECTED ARiRIVAL s ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />:'' i. .i GENERATOR COPY". MANIFEST At 4.96 <br /> I9[7 4 <br />