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CD Keller Canyon 13Coffin Butte 1:1Ox Mountain 11Newby Island.. 1?9 Forward <br /> Sanitary Landfill Landfill -Sair]tary- Landfill Sanitary Landfill Landfill <br /> t <br /> 901 Bailey Road ,28972 Coffin Butte Road' 12510 San.Mateo Road 1601 Dixon Landing Load 9999 S.Austin Road <br /> Pittsburg, GA 94565 Corvallis, OR 97330 Half Moon Bey,CA-94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> T Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 <br /> Phone(209)982-4298 <br /> Fax(925)458.9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-10179 <br /> �= <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> HcaWASTE ACCEPTANCE NO. <br /> clar�t�Ir�c�ctut . <br /> MAILING ADDRESS <br /> rnAve. .— <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE.EQUIPMENT <br /> at �T GLOVES . 0 GOGGLES ❑RESPIRATOR HARD HAT <br /> PHONEE A _ , <br /> 209 469-0095 0 TY VEK a SAFETY VEST <br /> CONTACT PERSON <br /> Krdt.0 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 281 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 heaefdous waste <br /> subject to the Lard Disposal Restrictions;I certify and warrant that the waste has been treated InRECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 2131. <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> 0 CONSTRUCTION 0.WOOD <br /> 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W,Hw--.4ixi Ave UT(Y7+TON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NSE NUMBER TRUCK NUMBER <br /> Mr. )'r7Jt.-er <br /> ADDRESS �_ /,,),6 � /'� � I /01--/ <br /> 2710 LCcAAS l�tr�arf 7'WTV <br /> CITY,STATE,ZIP <br /> ua>* <br /> PHONE END DUMP BOTTOM DUMP TR NSFER <br /> QW) 6-1141 <br /> SIGNATUR OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 1 CUBIC YARDS <br /> I 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 /> REMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBFJ9 DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNAT RE F AUTHqAIZED AGENT , -DATE , <br /> 0 WOOD_ <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULIN MU TBE MADE PRIOR TO 3:00 I?M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL ON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# <br /> 564790 <br />