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11Xeller Canyon.-" ❑Coffin Butte ❑Ox Mountain El Newby island LSI Forward <br /> . Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 32310 San Mateo Road 1601 Dixon.Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Muofi 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(209)982-4298 . <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183F2x(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> HatfirRePmxxft WASTE.ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 71175 W, � 6939- <br /> vt: — <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> �t:l,t'A 2� <br /> HONE 5 GLOVES ❑GOGGLES o RESPIRATOR NO HARD HAT <br /> � ' -�Z: 0 TY VEK U SAFETY VEST <br /> MAILING <br /> PERSON <br /> Brdt.Ccll Kn SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material Is nota hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classitled and peoMged,and Is in proper condition for transportation a^cording to applicable <br /> regulations;AND,if the waste Is a treatment residue of a previously restriotod 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 268 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 O WOOD <br /> O DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2OZS"W':Hl ltam Ave UTOC&I TON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> W.Trucker - <br /> ADDRESS ,oO 6.. . <br /> 27 10 I#taar[ s 1 oed <br /> CITY,STATE,ZIP <br /> St tali;C-A q5205 <br /> PHONE END DUMP BOTTOM DUMP' TR NSF R <br /> 456-11 5 ❑ ❑ <br /> SIGNAT UTHORIZED AGENrQP DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS_ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLt=TED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE. OTHER <br /> EMARK O SOIL <br /> U CONSTRUCTION. <br /> FACILITY TICK15T NUMBPR j , DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE)QFAQTkiOOIZEDIAGENT DATE <br /> U WOOD <br /> ❑ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST ADE PRIORTO 3: IS M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILLTHE DAY BEFORE, <br /> GENERATOR,COPY MANIFEST# <br /> 58.4781 <br /> Q <br />