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IJ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island C ;Forward <br /> 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 Phorfe(541)' 45-2018 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 /> i <br /> NON-HAZARDOUS WASTE MANIFEST <br /> f [PHONE <br /> ERATOR <br /> �,WK�,� WASTE ACCEPTANCE NO. . <br /> NG ADDRESS <br /> ril Et:f +tFl SVS73 9690 <br /> STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> k n,CA 2 <br /> 5GLOVES UGOGGLES 0RESPIRATOR HARD HAT <br /> 469"�' ❑TY VEK Cl SAFETY VEST <br /> ACT PERSON <br /> Brdt.Cc+LI&''l SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I horsby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or dile 22 of the California code of regulations,has bean property <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 resldue of a previously restricted hazardous waste_ <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has bean treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> S W,HAWItr,A.t Ame STOCt<.'TON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS LD`"" �? 0 � 'C'- <br /> �71 t1 crti�R�t+i ' <br /> CITY, STATE,ZIP <br /> PHONE . END DUMP BOTTOM DUMP TRANSF R <br /> (2 . 4-5&114+ e ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER -DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> c., ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MAQE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL+ANY UNSCHEDULED LOADS ARE SUBJECT <br /> JO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST'SE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> CP <br /> P <br /> GENATbA CIOPY a MANIFEST# `�v0/1 +�F"1 <br />