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❑ Keller Canyon <br />Sanitary lmndfili^ <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />O Coffin But- <br />Ll Ox Mountain <br />❑ Newl— Island <br />Landfill <br />Sanitary Landfill <br />Sant y Landfill <br />28972 Coffin Butte Road <br />12310 San Mateo Road <br />1601 Dixon Landing Road <br />Corvallis, OR 97,330 <br />Half Moon Bay, CA 94019 <br />Milpitas, CA 95035 <br />Phone (541) 745-2018 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Fax (541) 745-3826 <br />Fax (650) 726-9183 <br />Fax (408) 262-2871 <br />mf)N.Ne7ARD0US WASTE MANIFEST <br />iei-Vorward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERATOR <br />WASTE ACCEPTANCE NO. <br />N � <br />MAILING ADDRESS <br />_ <br />69 3 6 - 7 <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />GLOVES trI OGGLES (;Ji, `SPIRATOR ,D HARD HAT <br />p-4-VEK SO SAFETY VEST <br />CITY, STATE, ZIP <br />PHONE <br />CONTACT PERSON <br />�-Y <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT / T TLE 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 />described, ckmiliied and packaged, and is in proper condition for transportation a -cording to applicable <br />regulations; AND, 11 the waste Is s treatment residue of a prevlousty restricted hexerdous waste <br />subleO to the Lind Disposal Restricti0m, i certity, and warrant that the waste has been treated in <br />accordance with the reWirennents of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br />40 CFR Pan 261. <br />RECEIVING FACILITY <br />WASTE TYPE: <br />DISPOSAL U SLUDGE <br />CONSTRUCTION O WOOD <br />l� DEBRIS U OTHER <br />U SPECIAL WASTE <br />GENERATING FACILITY <br />C.Sus <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER <br />TRUCK NUMBER <br />S <br />ADDRESS <br />END DUMP BOTTOM DUMP TRANSFER <br />Ll <br />ROLL-OFF(S) FLAT-BED VAN DRUMS <br />F-1 r-11 f-) <br />rt a <br />CITY, STA , ZIP <br />tncktC 95215 <br />_ <br />PHONE <br />z _ <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br />I hereby certify that the above named material has been 7v <br />accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />is true and accurate. <br />I DISPOSE OTHER <br />U SOIL <br />REMARKS O CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER ❑NON -FRIABLE <br />ASBESTOS <br />SIGNA E O AUTHQRIZED AGENT DATE U WOOD <br />A �.�✓%�; I � \� I \J` ❑ASH <br />U SPECIAL OTHER <br />SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL -ANY UNSCHEDULED Li <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL <br />GENERATOR COPY, MANIFEST # <br />RE SU ECT <br />kY BEFORE. <br />900in N0110AXISNOD 913H 0190 ZE6 60Z YVA yVV:ZT 800Z/60/ZO <br />