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p Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> Sanitary,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)726.1819 Phone(408)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 ,�I,^ g <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE !GLOVES U GOGGLES 0 RESPIRATOR HARD HAT <br /> 2u1 ''�l�';{a^Ct 35 U TY VEK U SAFETY VEST <br /> CONTACT PERSON <br /> }krgt, �� s � SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named malarial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation air ording to applicable <br /> regulations: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 Pad 268 and is no longer a hazardous wash as defined by <br /> 40 GFR Part 261. ' <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ZG25 W,Iia:+�tlutx:� t. nTe,tt�t It I <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> 2710L,:" Ii,-,Fc: <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> f 209 t 456-)14.5 ❑ ❑ Qj <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 hereby certify that the abase named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMRLETI=D BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> } U NON-FRIABLE <br /> 0 . ASBESTOS <br /> SIGNATURE OF AUTj4ORIZED AGENT DATE <br /> _ ❑WOOD <br /> ❑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 /> GIcNERATOR COPY MANIFEST# °�. 4 .8 <br />