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Keller Canyon. ❑Coffin Butte ❑Ox Mountain ❑ Newby,l land 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)745-2016 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 I3eadt3rvr Remtrm WASTE ACCEPTANCE.NO. <br /> MAILING ADDRESS <br /> 7OZ W. mve. __ <br /> CITY, STATE,ZIP REQUIRED PERSONAL <br /> Stodda4CA 95203 PROTECTIVE EQUIPMENT <br /> PHONE NGLOVES ❑GOGGLES ❑RESPIRATOR . Y7 HARD HAT <br /> '0625 Q TYVEK Q SAFETY VEST <br /> CONTACT PERSON <br /> Breft Coulow 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 We 22 of the Callfomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> regulations;AND,If the waste Is a treatment residue of s 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 CFA Part 261. <br /> WASTE TYPE: <br /> 4 DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION Q WOOD <br /> Q DEBRIS Q OTHER <br /> ❑SPECIAL.WASTE <br /> GENERATING FACILITY <br /> 2W W ffimllton Aare SWCKTON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER " TRUCK NUMBER <br /> DESS <br /> natker. [A , <br /> 1110 Loun-iii A Road <br /> CITY,STATE,ZIP <br /> 3toddon.CA9.5205 <br /> PHONE END DUMP BOTTOM DUMP . TRANSEER <br /> 2 456.1145 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLATBED- VAN DRUMS <br /> Ji <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL-METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBR1S <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUT OR[ZED AGENT DATE ASBESTOS <br /> ❑.WOOD <br /> ��L[LQ <br /> , 0 ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAJ_ UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE: <br /> 'i 3ENERATOFR COPY MANIFEST# �_64$97 <br />