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0 Keller Canyon" ❑Coffin Butte ❑Ox Mountain ' ❑ Newby Island [N Forward <br /> R' Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> ',' 901 Bailey Road 28972 Coffin Butte Road 1231.0 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 /> i 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 i'ax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> T3c�shv�t�xtr�cx� <br /> MAILING ADDRESS <br /> ,41123 W.111z cin 77ve — <br /> 939 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> - fis#ctnrt' GLOVES 0 GOGGLES <br /> PHONENO❑RESPIRATOR � HARD HAT <br /> (2W)469-000 0 TY VEK O SAFETY VEST <br /> CONTACT PERSON <br /> 7'trettt�tna t 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 bean properly <br /> described,classified and packaged,and is In proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste Is s treatment residue of a previously restricted 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 /> 1 40 CFR Part 261. I <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> 0 CONSTRUCTION Q WOOL] ' <br /> 0 DEBRIS 0 OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2M W 1•TFizeitce Ave <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mir.TWIT'er <br /> ADDRESS � � ( 7 <br /> 271]T.mnis Rt•)nnl <br /> CITY,STATE,ZIP <br /> tx-N, <br /> PHONE END DUMP BOTTOM DUMP. TRANSFER <br /> (209)456,1145 ❑ <br /> SIGNATURE OF AUTHORIZEJD AGENT OR 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 COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE, OTHER <br /> EMARKS O SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> U'ASH <br /> f � <br /> UI SPECIAL OTHER <br /> SCHEDULING MUST 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 fe 564798 <br />