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❑Keller Canyon ❑Coffin BU1.__ i❑Ox Mountain ❑ Ne Island AForward <br /> Saritary,Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Roil„. 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Hall 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 /> T• GENERATOR - WASTE ACCEPTANCE NO. <br /> OA <br /> MAILING ADDRESS _ <br /> ro ! v 0 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> GLOVES O'GOGGLES p'4ESPIRATOR XL]HARD HAT <br /> PHONE �`�• <br /> r �'Y--VEK M SAFETY VEST <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 7k' <br /> GENERATOR'S CERTIFICATION:I hereby certify thal the above named malarial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of bre California code of regulations,has bean property <br /> described,classified and packaged.and is in proper oondnion for transportation a-cording to applicable , <br /> reguiabons;AND,ff the waste Is a treatment residue of a previously restricted hazardous waste <br /> subled to 04 land Disposal Restrictions,1 certify and warrant that the waste has(wen treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined try <br /> 40 CFA Part 261. <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> CONSTRUCTION O WOOD <br /> DEBRIS U OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> Al <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> B Cvnstru d Inc. <br /> ADD ESS <br /> L4§3 S.14wv PP ELoro Road <br /> CITY,STATE,ZIP <br /> ii&ckton,CA 95215 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER ' <br /> 932-0606 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> p ❑ ❑ ❑ <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 /> Y <br /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATILIFIE QF ALqrHORIZED AGENT DATE <br /> _ U WOOD <br /> U ASH � <br /> �L I1 777 f iii ,1 <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO3:00 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 DAY BEFORE. <br /> i <br /> GENERATOR COPY MANIFEST# 4 9 3 0 0 2 <br /> in <br /> 400In NOI.LDI HISNOD 9133 OT90 ZE6 60Z Ydd Eb:ZI SOOZ/60/ZO <br />