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❑ Keller Canyon ❑Coffin Bu, ❑Ox Mountain ❑ Ne- Island forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sant. ry Landfill Landfill <br /> a <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 /> 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 /> C_ON5 f A/<= <br /> MAILING ADDRESS `30 <br /> J <br /> CITY, STATE,ZIP / REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> N G GLOVES U GOGGLES U RESPIRATOR �HARD HAT <br /> PHONE <br /> O TY-VEK :0 SAFETY VEST <br /> CONTACT PERSON i SPECIAL HANDLING PROCEDURES: <br /> fir <br /> / Lc <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 try 40 CFR Part 261 or fide 22 of the California code of regulations,has been property <br /> described,classified and packaged.and is in proper condition for transportation a-cording to apptirable <br /> regulations;AND,It the waste is a treatment residue of•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 GFR Pan 261. <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> CONSTRUCTION U WOOD <br /> I�DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> us <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> B Comtracano 9,0 z 2 <br /> ADDRESS <br /> 6P,S.HM,P9 IiYonnge Rgad <br /> CITY,STATE,ZIP <br /> tocktor,Ck 9 5 215 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 09)o32-461 6 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENTIOR 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 /> U SOIL <br /> REMARKS—, U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKU NUMBO U NON-FRIABLE <br /> 1 11 ASBESTOS <br /> SIGNATU OF AUTHCPIZED AGENT DATE <br /> ❑WOOD <br /> Ll, 1 U ASH <br /> O SPECIAL OTHER <br /> 1 <br /> SCHEDULNCvMUST 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 D E. <br /> GEUkRATOf?COPY MANIFEST# q 5 Q <br /> v <br /> E00[n N0110 [HISNOD UVH OT90 ZE6 609 YVA Zt:ZT 800Z/b0/ZO <br />