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❑ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island A 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 /> i, Pittsburg,CA 94565 Corvallis, QR 97330 Halt Moon Bay,-CA 94010 Milpitas, CA 95035 Manteca, CA 95336 <br /> I Phone(925)458-9800 Phone(54.1)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 <br /> �e bm11we — <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 6 GLOVES U GOGGLES U RESPIRATOR NO HARD HAT <br /> ❑TY VEK © SAFETY VEST <br /> CONTACT PERSON <br /> Brdt-Cmflgm 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 code of regulations,has boon propedy <br /> described,classified and packaged,and is in proper condition for transportation a'oording to applicable <br /> regulations;AND.It the waste is a treatment residue of a previously restricted hazardous waste <br /> suhiect 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 /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> xi <br /> 0 DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> l,i 'Iff�f__� <br /> ADDRESS ' I <br /> 2710 T.;�x �►i :+gid <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE QF AUTHORIZED AGENT OR DRIVER DATE <br /> ROLL-OFF(S) FLAT BED VAN DRUMS <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 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> h ❑CONSTRUCTION <br /> FACILITY.TICKET NUMBER �DEBRIS <br /> Q NON-FRIABLE <br /> 1 ASBESTOS <br /> SIGNATURE'OF AUTHORIZEDIAGENT DATE <br /> Y ti ❑WOOD <br /> Li ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULIN •MftT BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST 9 �� 4 �4 6 <br />