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El <br /> Keller Canyon ❑Coffin Butte ❑Ox Mountain Newby Island X Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> N 901 Bailey Roach' 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 /> 1`: ',Phone(925)456-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)946-2800 Phone(209)982-4298 <br /> ` Fax(925)459-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)2.62-2871 Fax(209)982-1009 <br /> 1 NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Hc�lahvatr<rFte tr is WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 11imm Ave. 6939 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTI/E.EQUIPMENT <br /> PHONE 3GL6VES Q GOGGLES ❑RESPIRATOR U HARD HAT <br /> 20Y 469"%2 ❑TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> Fr—cif c5il om 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 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is In proper condition for transportation s-.cording to applicable <br /> regulaffons;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,f 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 U SLUDGE <br /> U CONSTRUCTION O WOOD . <br /> U DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20 5 V+f.1-14MItarl Ave STOC "TOS <br /> TRANSPORTER NOTES: VEHICLELICENSENUMBER=)�7 <br /> TRRU NUMBER <br /> Mr.U-513 <br /> ADDRESS6f 0-771165 <br /> 3710 1Ax4iriv Rtm11 <br /> CITY,STATE,ZIP' <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (7W)456-114 ❑ <br /> SI PQA URE IF AUTHORIZED AG Ey 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 BE COM LETED,BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑yfiOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS- <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED ADEN DgTE. <br /> O WOOD <br /> U ASH <br /> Q SPECIAL OTHER ! <br /> I <br /> I <br /> SCHEDULING MUST BE MADE PRIO0I70'3:00 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 CORY MANIFEST# 5 6 4 7 9 4 <br />