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Keller Canyon ❑Coffin Butte ❑Ox Mountaim "❑ Newby Island ® Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road _ 28972 Coffin Butte Road -112310 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)945-2600 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> t�c�stlaxst�.r�c;�:xuxx� <br /> MAILING ADDRESS _ 6939 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> St& Im`47A GLOVES 0 GOGGLES ❑RESPIRATOR 7 HARD HAT <br /> PHONE <br /> U TY VEK QI SAFETY VEST <br /> CONTACT PERSON <br /> Brdt Ccalllscrnl SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S CERTIFICATION:l hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tills 22 of the Caldomia code of regulations,has been property <br /> described,classified and packaged,and Is in proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste is a 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 /> 40 CFR Part 261. - - <br /> WASTE TYPE: <br /> X DISPOSAL U SLUDGE <br /> 0 CONSTRUCTION U WOOD <br /> •DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W.Z e:ltoti Ave <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mr.Trwker <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> Stoll t,X1.1"A Y <br /> PHONE END DUMP BOTTOM DUMP TRANS ER <br /> Q-- <br /> 061)456-11145 ' <br /> SIGN UR OF AUTHORIZED A E T OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS <br /> ."9W—er V <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 /> U SOIL <br /> .FtEMARK <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> .FACILITY TICKS NUMB O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTH RIZED AGENT DATE <br /> Q wooD <br /> •ti <br /> ! U ASH I <br /> U SPECIAL OTHER <br /> SCHE ULINGT BE MADE PRIORTO 3:00 P M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFOSAi 3ON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 5647.95 <br /> 6 4 7`©J <br />