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1:1 Keller Cyo , El Coffin Butte ❑Ox Mountain ❑Newby Island I Forward <br /> Sanitary"Landfill Landfill Sanitary.Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 1231.0 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 Manteca,CA 95336 <br /> Phone(925)456-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax.(541)745.3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> i <br /> NON-HAZARDOUS WASTE MANIFEST , <br /> GENERATOR <br /> H ctwafefRc x a WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS pp <br /> CITY,STATE,ZIP REQUIRED PERSONAU PROTECTIVE EQUIPMENT <br /> .Gps 9SZ03. <br /> PHONE GLOVES 0 GOGGLES 0 RESPIRATOR. ]HARD HAT <br /> 469- 625 <br /> 0 TY VEK 0 SAFETY VEST <br /> CONTACT PERSON <br /> BirdtCcdom 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 Ped 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,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the sand Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING` FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL CI SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> U DEBRIS O OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.Hawltm Ave STOt I�`pN <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER. <br /> ADDRESS 8:& 0-7769le : <br /> '�• 2'7l q nls}five -, <br /> CITY,STATE,ZIP <br /> StorftMCA 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANS ER <br /> (209)456-1145 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER ' DATE. ROLL-OFFS FLAT-BED' VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certifythat the above named material has been <br /> accepted and to the best of m ..�n w edge the foregoing DISPOSAL METHOD: (To BE COMPLETED BY LANDFILL) <br /> i e'and ,ccs rate. i <br /> ' DISPOSE OTHER <br /> EMARKS 0 SOfL <br /> 0 CONSTRUCTION. <br /> FACILITY TIC ER DEBRIS <br /> 0 NON -FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Gi ASH <br /> Cl SPECIAL OTHER <br /> SCHE NG MUST BE MADE PRIORI'O 3: FIE DAY PRIORTO.EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSA PAN-ARR}V�4t_. OING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE: <br /> GENERATOR COPY MANIFEST hi:. /177"0 <br />