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❑ Keller Canyon ❑Coffin Butte 0 Ox Mountain El Newby Island ®Forward <br /> §anitary.Landfill Landfill Sanitary Landfill S;anitar Landfill <br /> =•i. ill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road iBD1 Dixonending Road 9999 SfAustin Road <br /> Pittsburg, CA 94565 Corvallis,OR 97330 Half Moon Bay,CA 94019 PAIPitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> f Fax(925)458-9891 Fax(541)7.45-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(2p9)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> H-Mift(dwRe%XWccas WASTE.ACCEPTANCE NO <br /> MAILING ADDRESS <br /> 69,39 <br /> CITY, STATE,ZIPatoddMCA REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 5GLOVES U GOGGLES D RESPIRATOR ]HARD HAT <br /> ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> Hnt#t-e 116M SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261.or He 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 hazardous waste <br /> subject to the Land Disposal Restrictions,I cern and warrant that th <br /> certify waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longeo r a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> M DISPOSAL Q SLUDGE <br /> ID CONSTRUCTION" U WOOD ' `, <br /> ID DEBRIS t]OTHER <br /> SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2C725'W,l LR&It1X1 Avg t t'TON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mr.Trucker <br /> ADDRESSGZ <br /> s Rwid <br /> CITY,'STATE,ZIP <br /> 9t0ftMCA Q5205 .� <br /> PHONE END DUMP BOTTOM.DUMP TRANSFER <br /> . 45&1 W, <br /> SIGN AUTH D AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS <br /> 07 <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 /> s <br /> DISPOSE ' OTHER '"} <br /> EMARKS O SOIL <br /> U CONSTRUCTION ti <br /> FACI I TICKS NUM ER DEBRIS <br /> . ❑tiON-FRIABLE " <br /> ASBESTOS <br /> SIGNA U E 09 AUT"IZED.A ENT DATE <br /> o WOOD r <br /> 0 ASH <br /> t U SPECIAL OTHEW =' <br /> SCHEDULING MUST BE MADE PRIORT0 3:00 P.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 /> ++?? <br /> .56495 <br /> ]CC <br /> C3Et�ER ©r�COSY :.' , MANIFEST#. O{"]v3 <br /> ,'` <br />