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LII(eller Canyon []Coffin Butte ❑Ox Mountain <br /> Sanitary Landfill Landfill El Newby Island ®Forward <br /> •901 Bailey Road Sanitary Landfill Sanitary Landfill Landfill . <br /> 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road <br /> Pittsburg, CA 94565 Corvallis, OR 973309999 <br /> I' Phone(925)458-9800 Phone(541}745 2018 Half Moon Bay,CA 94019 Milpitas, CA 950359 Manteca, <br /> Austin Road <br /> Manteca, CA 95336 <br /> Fax(925)458-9891 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(541)745-3826 Fax(650)726-9183 Fax 408 <br /> "a ( )262-2871 Fax(209)982-1009 <br /> E NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Hct R a>t WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ve <br /> CITY, STATE,ZIP <br /> t'cm, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t� <br /> PHONE KGLOVES ❑GOGGLES ❑RESPIRATOR ]HARD HAT <br /> 4C9-O6Z3 ❑TY VEK 0 SAFETY VEST <br /> CONTACT Pr=RSON <br /> t C f�cn SPECIAL.HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not it hazardous <br /> waste as defined by 40 CFR Part 281 or tide 22 of the California code of regulations•has been propedy <br /> described,classified and packaged,and is in proper condition for transportation a-.cording to applicable <br /> regulations:ANq If the waste Is a treatment residue of a previously 1estelcted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 GFR Part 288 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 4 DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2l5 fit,Ramittxn Ave 3T Or—wroN_ <br /> TRANSPORTER <br /> N <br /> M1;Tnldtfr OTES:. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> q <br /> ADDRESS "L2tx,. <br /> 2710 1090i Road <br /> CITY,STATE,ZIP { <br /> St 'ON42A 95205 J <br /> PHONE ' END DUMP BOTTOM DUMP TRANSFER �p <br /> 1 45�+-114-51 � � � I <br /> SIGN R OF AUT IZED AGENT OR DRIVER DATE ROLL-OFFS FLAT BED VAN DRUMS <br /> i -7 <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 /> DISPOSAL METHOD: (TO BEC P- ED BY LANDFILL) . <br /> is true and accurate. <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> A NON-FRIABLE <br /> SIGNATU E OF AUT ORIZED AGENT DATE <br /> ASBESTOS <br /> a^-�r- .I:.�.-•" CI WOOD <br /> Q ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THIE DAY PRIORTO EXPECTED.A,RRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST.BE SCHEDULED WITH TH '`1rANDFIL.L THE DAY BEFORE... <br /> ,•,.. G <br /> ENEf1ATORCC1P•Y MANIFEST# J64947 <br />