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Q Keller Canyon ❑Coffin Butte ❑Ox Mountain s^' El Newby Island IN Forward <br /> Sanitary Landfill Landfil`I 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 Phone(209)982-4298 <br /> s Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 - Fax(209)982-1009 <br /> NON-HAZARDOUSWASTE MANIFEST.. <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hct at�rRetr+:.r� <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> M�xklrClidtf. GLOVES ❑GOGGLES ❑RESPIRATOR >bHARD HAT <br /> PHONE <br /> 2 469.0625 ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> Drdt.C a 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 /> desoribed,'classified and packaged,and Is in proper condition for transportation a-cording to applicable <br /> regulations:AND,tf the waste is a treatment residue of a previously restricted hazardous weste <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 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> obEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2075 w I-welt(l,AVC am{w&JON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> x7317 L�,nift Riad <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2Esl45&1145 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> 99 <br /> MARK$ C]SOIL <br /> l ❑CONSTRUCTION <br /> FACILITY TICK T NUMBER DEBRIS <br /> i <br /> ❑NON-FRIABLE " <br /> ASBESTOS <br /> SI NA TU IO AUTHORIZED AGENT __QATE <br /> ❑WOOD <br /> Q ASH <br /> ❑SPECIAL OTHER <br /> SCHEDUL'INd MUSTNE MADE PRI ff 3.00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL, ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE: <br /> - C�ENEfiATOR COPY o MANIFEST# 8 1 9 <br />