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❑°Keller 9,,anyon. r O Coffin Butte ❑Ox Mountain ❑Newby Island L Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary 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 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(2[79)982 4298 <br /> 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 <br /> HeWwatcrRvtmt WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP95 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE GLOVES U GOGGLES U RESPIRATOR �EI HARD HAT <br /> i - ❑TY-VEK 'U SAFETY VEST <br />! CONTACT PERSON <br /> Brett Otrtel l SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERTOR'S CERTIFICATION:i hereby codify that the above named material Is not a hazartlous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California coda of regulations,has been property <br /> described,classified and packaged,and is in proper condiiiorn for transportation a-cording to applicable <br /> regulations;AND,It the waste to a treatment residue of a prevlouby restricted hazardous waste <br /> subject 10 the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordancege <br /> with the requirements of 40 CFR Part 268 and is no lonr a hazardous waste as defined by <br /> 40 CFR Past 261. <br /> WASTE TYPE: <br /> X DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> Q DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 24)'l5 W.H Iton Ave <br /> TRANSPORTER " <br /> Tt�,t+�c�er NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 7 70- <br /> 27 10 Loun is Romi <br /> CITY, STATE,ZIP <br /> BtOddorli,CA P52-05 <br /> PHONE END DUMP BOTTOM DUMP TRANSF R <br /> "Z QSIS-ll - <br /> SIGNATURE OFA HORIZE TOR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r <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 /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE' OTHER .. <br /> EMARKS '!U-SOIL' <br /> Q CONSTRUCTION <br /> FACILITY K NU BER DEBRIS <br /> ❑NON-FRIABLE'' <br /> .SIGN URE gF UTH RIZED AGENT p ASBEST05 <br /> AT9,nij <br /> U WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING M,U§T BE GE PRIOR TO 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 THE DAY BEFORE: <br /> GENERATOR COPY MANIFEST# 5, 47,79'. <br />