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0.-Xdllei r Canyon . Coffin Butte ❑Ox Mountain <br /> 3 - CJ Newby Island [ Forward <br /> Sanitary�Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> . 901 Bail+?y Road 28972 Coffin Butte Road 12310 San Mateo Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 1601 Dixon Landing Road 9999 S.'Austin Road <br /> Phone(925)458-980D Phone 54i 745-2018 Half Moon Bay;CA 94019 Miljbitas, CA%so35 <br /> ( ) Phone(650)726-1819 Phone(408)945-2800 Phone(209).982 4298, <br /> Mante0a, CA.96 <br /> Faz(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax 408 262-2871 <br /> 1=ax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Hva� Lu1ee WASTE ACCEPTANCE N0 <br /> MAILING ADDRESS . <br /> CITY,STATE,ZIP - <br /> tm,t'A 5�3 REOUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I. <br /> St . <br /> PHONE NGLOVES O GOGGLES Q kESP iRATOR ]HARD HAT <br /> CONTACT PERSON O TY VEK O SAFETY VEST <br /> Brett Ccfulf�on SPECIAL <br /> HA <br /> ND <br /> LING P <br /> AOGED <br /> UR <br /> E . <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE GATE S <br /> GENERATOR'S CERTIFICATION:Thereby certify chat the above named material is not a hazardous' <br /> waste as defined by 40 CFR Part 261 or Iitie 22 of the California code of regulallons,hi's been properly <br /> desc.bud.classified and packaged,and Is In proper condition for transporialk, a cording to applicable' <br /> regulations;AND,If the Waste in a treatment residue al a previously r wrk heterdous waste <br /> sublet!to the Land Disposal Restrictions,I cenily and warrant tha!the waste has been treated In - <br /> accordance with the requirements of 40 CFR Pert 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE; <br /> -V DISPOSAL O SLUDGE. <br /> U CONSTRUCTION. ❑WOOD <br /> U DEBRIS. U OTHER <br /> USPECIAL WASTE <br /> GENERATING FACILITY <br /> 20 5 Wl;Rueltun Ave fit' GKTON <br /> TRANSPORTER NOTES. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 2tGr.Tnur�sr. _ . .. <br /> ADDRESS . _ <br /> 271+ LIMMis Road <br /> CITY,STATE,ZIP <br /> PHONE <br /> f2 45 11 END DUMP BOTTOM DUMP TRANSFER . <br /> SIGNATURE OF AUTHORIZED AGENT.OR DRIVER DATE ROLL OFFS FLAT-BED-:. VAN. DRUMS <br /> a [ ❑ <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 /> EMAAKS <br /> U CONSTRUCTION <br /> FACI 41TYTICK NUMBER .DEBRIS <br /> U NON-FRIABLE <br /> SIGN A USE OF AUTWORIZEDAGENT DATE ASBESTOS <br /> ❑WOOD <br /> O ASH <br /> i <br /> U SPECIAL OTHER <br /> SCHEDULIN MU T BE MADE PRIORTO 3:00 P.M.TkE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 70 REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES.MUST BE-SCHEDULED.WITH THE LANDFILL,THE% ,�bm BEFORE. <br /> GENERATOR COPY MANIFEST:# -V 4 3.4 <br />