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K-eller.Ganyon ❑Poffin Butte ❑Ox Mountain ❑Newby Island LM Forward <br /> Sanitary Landfill Landfill Sanitary:Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 Sari 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(40B)945-2800 Phone(209)9824298 <br /> t :Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)98241009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> -Headw*d-iCc;T xx <br /> MAILING ADDRESS _ <br /> 2W W.HiEatm Ave <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> StoMcn,CA GLOVES Q GOGGLES ❑RESPIRATOR A0 HARD HAT <br /> PHONE <br /> (209)469-0675 ❑TY-VEK L) SAFETY VEST. <br /> CONTACT PERSON <br /> 1t.0 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 Califomia code of regulations,has been properly ' <br /> described,classified and packaged,and is In proper condition for transportation axording to applicable <br /> regulations;AND,if the waste Is s treatment residue of a previously restricted haaardous 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 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261: <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> Q SPECIALWASTE - - <br /> GENERATING FACILITY <br /> 2025 W HamIton k,Pe STO+CKTON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS fid . <br /> 2710 L,amis Raid <br /> CITY,STATE,ZIP <br /> PHONEEND DUMP BOTTOM DUMP TRANSFER.- <br /> SIGN A O AUTHO GENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> M <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 BYLANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> I _ <br /> 1REMARKQ SOIL . <br /> Q,CONSTRUCTION <br /> DEBRIS <br /> FACILI TIC NUM ER <br /> 0 NON FRIABLE <br /> ASBESTOS ' <br /> SIGNATUR AUTH RIZED AGENT DATE <br /> U WOOD <br /> ' U ASH <br /> U,SPE . <br /> r _ <br /> GIAL OTHER <br /> smomw <br /> SCHEDULING MUST-161E MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> i TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE; DAY BEFORE. <br /> �' GENERATOfq CUPY ' MANIFEST# 5-64.906 <br />