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Ll Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> I Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 4!i. 901 BaileyRoad . <br /> .28972 Coffi;l 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(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 /> t NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR. <br /> Hradvattr Rcwia: WASTE ACCEPTANCE NO.. <br /> . <br /> MAILING ADDRESS 49 <br /> 2025 W. 95-W— ve — ALF <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sk sl,cn*CA 95=3 PHONE GLOVES ❑GOGGLES ❑RESPIRATOR �E]HARD HAT <br /> 4£9-0625 0 TY VEK O SAFETY VEST <br /> CONTACT PERSON <br /> r, t ccuirm SPECIAL HANDLING,PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE 11 <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 title 22 of the California code of regulations,has been properly, <br /> described,classified and packaged,and is in proper condition for transportation axarding to applicable. <br /> regulations;ANI),If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the band 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 ❑SLUDGE <br /> •CONSTRUCTION u woob <br /> a DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W,.HoUltun Ave UMCXr.7.0N <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBERf TRUCK NUMBER <br /> ADDRESS r-- <br /> L . 1 �� 'j. <br /> 2710 IQ Allis FjAci <br /> CITY,STATE,ZIP [ �� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (2W) 114.5 ❑ <br /> SIGNATURE OEAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <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 13E COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS o SOIL ' <br /> ❑CONSTRUCTION <br /> FACILI TICKET NUMB DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> LIGNATURE OF AUT ORIZED AGENT DATE <br /> ❑WOOD <br /> 0 ASH <br /> O SPECIAL OTHER <br /> SCHEDULI UST BE MADE PRIORTO 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 /> GENERATOR COPY MANIFEST# 564792 . <br />