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ED <br /> Keller canyon I�Coffin Butte ❑Oz Mountain . ❑ Newby.Island ®Forward <br /> j Sanitary Landfill Landfill Sanitary Landfill Sanitay Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San 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 <br /> F Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2600 Phone(209)982 4298 <br /> Fax(925)458-9691 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 a Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> i GENERATOR WASTE ACCEPTANCE NO. <br /> i H �,erR�a <br /> MAILING ADDRESS <br /> ,13 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIV EQUIPMENT <br /> PHONE 21 GLOVES .❑GOGGLES O RESPIRATOR NO HARD HAT <br /> 09 469'062 O TY-VEK © SAFETY VEST <br /> CONTACT PERSON <br /> BrdtCcW8Cn SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE . <br /> GENERATOR'S CERTIFICATION:I hereby eerlity 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 properly <br /> described,classified and packaged,and is in proper condition for transportation a--cording to applicable <br /> regulations;AND,It the waste Is s trsatment residue of a prsvleusly restricted hazardous 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 /> X DISPOSAL " O SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> O DEBRIS O OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> ZW W,H1wnRon Ave STOC[CT0111 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Trucke �i+ ii S-4 <br /> ADDADDRESSr <br /> s: <br /> �'71U I.aoritia I��d - <br /> CITY, STATE,�ZIP <br /> St fxt,CA95Z05 <br /> PHONE END DUMP BOTTOM DUMPTRA SER <br /> Z 45€&1 5 Li . <br /> Ll n <br /> SIGWMIRE OF AUTMORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED" VAN DRUMS <br /> CUBIGYARDS .. <br /> 1 hereby certify that the above named ma#eriel'has.be en <br /> accepted and to the`best of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED•BY LANDFILL) <br /> DISPOSE OTHER. <br /> EMARKS ❑SOIL. <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE " <br /> SIGNATU E OFAU H'ORIZED AGENT DATE ASBESTOS <br /> o�w000- <br /> LI ❑ASH <br /> IIV- <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE'SCHEDULED WITH THE LANDFILL.T;HE,DAY BEFORE. <br /> GENER,AT,6n COPY" MANIFEST# 6 9,10:7 <br />