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❑ Keller Canyon ❑Coffin Bt ❑Ox Mountain ❑ NE y Island L-forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sarmary 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 /> 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 n n WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS /�_ '"� a <br /> V <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES U GOGGLES U RESPIRATOR YJ HARD HAT <br /> PHONE <br /> O TY-VEK Np SAFETY VEST <br /> CONTACT PERSON <br /> � SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORFZE0 nENT/TITCE_ DATE <br /> GENERATOR'S CERTIFICATION:1 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 /> described,classified and paUtaged,and is in proper oondnion for transportafion a-cording to applicable <br /> regulations;ANO,If the waste is a treatment resldtte of•previously resUfcted hatardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordm <br /> accordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> CONSTRUCTION U WOOD <br /> DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 7,V <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS Inic <br /> [PVHONE <br /> STATE, ZIP <br /> 95 215 <br /> END DUMP BOTTOM DUMP TRANSFER <br /> n? 2_o6nei ❑ ❑ ❑ <br /> OF AUTHORIZED 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 <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> o <br /> EMARKS solL <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TI KET NUMB o NON-FRIABLE <br /> ASBESTOS <br /> SIGN TURE QF AUTH IZED AGENT DATE <br /> ❑WOOD <br /> O ASH <br /> O SPECIAL OTHER It <br /> SCHE LIN MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REF UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY B ORE. <br /> GFNERATOR COPY MANIFEST# <br /> 600ln N011D NISNOD 913H OT90 ZE6 60Z XVJ E6:ZT 800Z/60/ZO <br />