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❑ Keller Canyon L�l Coffin Butte ❑Ox Mountain ❑Newby island ON 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 /> II 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(448)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 6359 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ��`t.ttci:t >tl,t; ? Cfi GLOVES ❑GOGGLES ❑RESPIRATOR f]HARD HAT <br /> PHONE <br /> 4(0-ffiVS U TY VEK 4 SAFETY VEST <br /> CONTACT PERSON <br /> t'T. M C(Iu1W#'1 SPECIAL HANDLING PROCEDURES: <br /> k SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named materiat is not a hazardous <br /> waste as defined by 40 GFR 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 a-carding to applicable <br /> I regulations;AND,It the waste Is a treatment residue of a previously restricted ha=ardous 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 /> DISPOSAL Q SLUDGE <br /> •CONSTRUCTION ❑WOOD <br /> ❑DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W, 114itcht:1-t ikve <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSt 2�� <br /> 7,71t)[A4AIlif, <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) . 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 /> iEMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITYTICKET NUMBER DEBRIS <br /> 1 O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE�OF AU HORI D AGENT DATE <br /> % ❑WOOD <br /> U ASH <br /> r O SPECIAL_OTHER <br /> SCHEDULINP MU�r BIE 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 COPY MANIFEST# 4 7 <br /> 8 <br /> 6 <br />