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E Keller Canyon R ❑Coffin Butte .❑OX'Mountain ❑Newby Island L .Forward <br /> Sanitary Landflir-- 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(825)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(650y'726-9183 Fax(408)262-2871Fax{209}982-1009 <br /> bF. . <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> 1:ia�tl�A+ater'R�cumpt�I <br /> MAILING ADDRESS <br /> ve _. <br /> 693 <br /> CITY, STATE,ZIPBtocktm,CA 93203 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE - 5'GLOVE8 ❑GOGGLES O RESPIRATOR . NO HART]HAT <br /> 469-0625 ❑TY-VEK Q SAFETY VEST <br /> CONTACT PERSON <br /> Bmt•cowillim SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 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 been properly <br /> described,classified and packaged,end Is in proper condition for transportation a cording To applicable <br /> regulations;AND,If the wesle 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 46 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL Q SLUDGE <br /> O CONSTRUCTION rU WOOD <br /> ❑DEBRIS ❑OTHER <br /> a SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2(7?5 W,uelton Ave R"I ON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER: <br /> b r.Truckler <br /> ADDRESS 3SC� `I 76 <br /> 271Q L of niR Ruad <br /> CITY,STATE,ZIP <br /> Ut" 0r.'X.A 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER. <br /> 456.1145 ❑ <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS <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. alsr}osAL METHOD: (TO BE coMPLETED BY LANDFILL), . <br /> DISPOSE OTHER ' <br /> REMARKS o SOIL <br /> U CONSTRUCTION <br /> FA I ITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIG E OF AUTHORIZED AGENT DATE <br /> L)WOOD <br /> ❑ASH . <br /> x ❑SPECIAL OTHER <br /> ` SGH€DU N MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTo EXPECTED ARRIVAL•ANY UNSCHEDULED LOADSARE SUBJECT <br /> to REFUSAL .UPON ARRIVAL..ONGOING DAILY DELIVERIES.MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY. MANIFEST.# 6L49 05 <br />