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0 Keller Canyon,. ❑Coffin Butte ❑Ox Mountain , Q Newby Island IX Forward <br /> l 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 <br /> Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Faz(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> H�c1►vAtcr I�ct <br /> MAILING ADDRESS <br /> ATAD W, a, �AVU <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Riocktm 0` N GLOVES ❑GOGGLES ❑RESPIRATOR ]HARD HAT <br /> PHONE <br /> 469-OC-25 ❑TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> Brilt,C SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> I <br /> GENERATORS 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 o1 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 hazardous waste <br /> subject to Etre Land Disposal Restrictions,I certify and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261.. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> 4 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W.Haze lkiot>;Ave <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> hfr,Tnj*.Cr y <br /> ADDRESS r r TfQ <br /> 2710 Lmnis Road <br /> CITY,STATE,ZIP <br /> of ;tar)'C: X55 <br /> PHONE END DUMP BOTTOM DUMP TRAN FER <br /> 20Y 45&1145 ❑ <br /> SIG NATU E OF AUTHORIZE 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 BE COMPLETED BY LANDFILL) ] <br /> DISPOSE OTHER <br /> '�U SOIL <br /> REMARKS f <br /> ❑CONSTRUCTION <br /> FA ILI TICKET NU ER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGN,kTURFIOF AOTIHORIZeD AGENT DATE <br /> �. ❑WOOD <br /> I� \ U ASH <br /> U SPECIAL OTHER � j <br /> SCHEDIIN11"UST BE MADE PRIORTO 3:60. .M.THE DAY PRIO 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 4 7 9 9 <br />