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❑ Keller Canyon., ❑Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> Sanitaxy Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo 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)726-1619 Phone(406)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 WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ZU1_ <br /> 709 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT. <br /> Obo clmirl.A�..`i74 <br /> PHONE N GLOVES ❑GOGGLES ❑RESPIRATOR IN]HARD HAT <br /> (.-m3)`C'q-CK'i2 ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> Drdl,47,0 iJK'r, SPECIAL HANDLING PROCEDURES:. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION: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 rode of regulations,has been property <br /> described,classilied and packaged,and is in proper condition for transportation&-cording to applicable <br /> regulations;AND,If 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 Part 268 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261. <br /> WASTE TYPE: <br /> �Q DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS Q OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> 'X,23 W,I-Wt.'Itixt Ikw �aIOR.I;`Tt 1I <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS i � <br /> 27110 Lo«ji.isr,Fltm11 <br /> CITY,STATE,ZIP = <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209 456-1145 ❑ U a <br /> SIGNATU E OF AUTIJORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> hereby certify that the above named material has been i <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate.is METHOD: (TO BE COMPLETED t3Y LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑SOIL <br /> Q CONSTRUCTION <br /> FAC LITY TICKET NUMB R DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE',OF AUTHORIZED AGENT DATE_ <br /> ❑WOOD <br /> � r 1 ❑ASH <br /> ! -=E <br /> ❑SPECIAL OTHER <br /> SCHEDULIG M lS ISE MADEORIORTO 3:00 RM.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 CL1PYMANIFEST# 6 <br /> mf' 949 49 <br />