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El Keller Canyon D Coffin. Butte ❑OX'Mountain C1 Newby Island IM IF <br /> i Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixan 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 a Phone(541)745-2018 Phone(650)'726-1819 Phone(408)945-2800 Phone.(209)982-4298 <br /> I Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE:MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Heltdvttttcr Rt�tn� <br /> MAILING ADDRESS <br /> zoo W. ve <br /> CITY,STATE,ZIP REQUIRED-PERSONAL PROTECTIVE EQUIPMENT. <br /> MxddMCA 952W <br /> PHONE GLOVES _O GOGGLES 0 RESPIRATORI HARD HAT. <br /> (209)469-0625 O TY:VEK U SAFETY VEST <br /> CONTACT PERSON <br /> Brdt.cowKn SPECIAL HANDLING'PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S CERTiACA110N: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 property <br /> described,classified and packaged,and is In proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardque 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 Pert 268 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL Q SLUDGE <br /> U CONSTRUCTION ❑WOOD , <br /> O DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2A25 W,Hazeltim Ave STO+[wR'Tt N <br /> TRANSPORTER NOTES:. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS s Cr`g <br /> afi3D Loomis Roa <br /> CITY,STATE,ZIP <br /> as (*1„ - <br /> PHONE END DUMP BOTTOM DUMP. TRANSFER <br /> (209)456-1145 <br /> SIGWVPIE OF AUTUPRIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED" VAN DRUMS <br /> 4)�Ale,— <br /> CUBIC YARDS <br /> I hereby certify that the above namedmaterial:has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL <br /> METHOD: : (To BE CpnnPt=TEtS BY LANDFILL} <br /> Is true and accurate. <br /> DISPOSE.'. OTHER. <br /> REMARKS . ., ❑.SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE . <br /> .ASBESTOS <br /> SIGNATURE OF AUTtnRIZEDAGENT DATE <br /> . . ❑WOOD <br /> rJ r ❑ASN <br /> O SPECIAL OTHER : <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE-LANDFILL THE DAY BEFORE: . <br /> GEN'i`iRA'TOR Copy MANIFEST#, sr^- '� <br /> :. J A� <br />