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?El,Keller-4Canyon ❑Coffin Butte D Ox.Mountain <br /> Sanitary Landfill Landfill0 Newby Island IN Forward <br /> 901 Bane Road Sanitary Landfill Sanitary Landfill Landfill <br /> Y 28972 Coffin Butte Road 12310 San Mateo Road <br /> E: Pittsburg, CA 94565 Corvallis, OR 97330oon 1601 Dixon Landing Road 9999 S.Austin Road <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(65)726-819 19 Phiane(4CA 08)945328D0 Phone(209)9 5336 8 <br /> Manteca,CA 95336 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 <br /> Fax(209)982-1009 <br /> c NON-HAZARDOUS WASTE MANIFEST <br />` GENERATOR <br /> Ham' WASTE ACCEPTANCE NO. <br /> MAILING <br /> ADD ESS <br /> CfTY,STATE,Z1P REQUIRED PERSONAE.PROTECTIVE EQUIPMENT.+� <br /> PHONE GLOVES .Q GOGGLES. Q RESPIRATOR XQHARD HAT <br /> 469-0625 <br /> CONTACT PERSON <br /> Q TY-VEiK O SAFETY VEST <br /> BMt a t SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS CERTIFICATION:I hereby Certity that the above named material isnot a hazardous <br /> waste as defined by 40 CFR Part 261 or Ofle 22 of the California code of regulations,has been property <br /> described,otessitied and packaged,and is in proper condition for transportation alcording to applicable <br /> regulations;AND,If the waste In a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant chat the waste has been treated In <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> Q DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2.025 W,Hmital Ave MGIC KT011 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mr.Trucker <br /> ADDRESS <br /> 2710 Ltaomi9 Roe <br /> CITY,STATE,ZIP <br /> PHONE . <br /> N5f-114.5 END DUMP BOTTOM DUMP TRANSFER . <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATEROLL-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 DISPOSAL METHOD: (TO BE COMPLETED.BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER . <br /> REMARKS Q SOIL . x <br /> . Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS - <br /> 13 NON-FRIABLE <br /> SIG NATURE OFAUTHORIZ AGENT DATE ASBESTOS <br /> Q WOOD <br /> O ASH <br /> Q SPECIAL OTHER <br /> 90HEDULING MUST BE MADE PRIOR TO 3:00 R 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 COFY MANIFEST* <br /> 5,64908 <br /> 116 49.o QV <br />