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❑ Keller Canyon <br />Sanitary Landfill' <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />I <br />❑ Coffin Butt <br />Landfill <br />28972 Coffin Butte Road <br />Corvallis, OR 97330 <br />Phone (541) 745-2018 <br />Fax (541) 745-3826 <br />❑ Ox Mountain <br />Sanitary Landfill <br />12310 San Mateo Road <br />Half Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />❑ New' Island <br />Sani y Landfill <br />1601 Dixon Landing Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <br />Fax (408) 262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />� rward <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 />MAILING ADDRESS <br />S3 O— 7 �Z O <br />✓0 <br />CIN, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />Q L <br />GLOVES O GOGGLES O RESPIRATOR XJ HARD HAT <br />O TY-VEK 3Q SAFETY VEST <br />PHONE <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />,` �__ <br />SIGNATURE OF AUTHORIZED AGENT / TITLE <br />DATE <br />GENERATOR'S CERTIFICATION: I hereby comity tial the above named material is riot a hazardous <br />waste as defined by 40 CFA Part 261 or title 22 of the California code o1 regulations, has been property <br />described, classified and packaged, and is in proper condition for transportation a -cording to applicable <br />lousfy stricted hazardous waste <br />regulations: AND, If the waste lea treatment residue of a prwre <br />subied lo the Larld otspoaal Reslrichons. I cerYfy, and warrant that the waste has been treated in <br />accordartce with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br />40 CFA Part 261. <br />RtCEIVING FACILITY <br />, <br />WASTE TYPE: <br />QI DISPOSAL U SLUDGE <br />CONSTRUCTION O WOOD <br />O DEBRIS ❑ OTHER <br />O SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />ADDRESS <br />END DUMP BOTTOM DUMP TRANSFER <br />❑ ❑ <br />ROLL -OFF FLAT-BED VAN DRUMS <br />i0,1q PW%Y <br />CITY, STATE, ZIP <br />acb3 0.495215 <br />PHONE <br />IGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <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. <br />CUBIC YARDS <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />O SOIL <br />EMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />O NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF TH RIZ D AGENTDAT <br />O WOOD <br />/ <br />�Z.jO <br />f l i <br />„I <br />"ASH <br />O SPECIALOTHER <br />SCHEDU `G MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED <br />Tn OCCIICAI trona AootvAI n1klf2flfufn nelly ncI mgmwS UIIAT <br />ARRIVAL s ANY <br />RE SCHEDULED WITH <br />UNSCHEDULED LOADS ARE SUBJECT <br />THE LANDFILL THE DAY BEFORE. <br />GENERATOR COPY "' <br />L 0 0 in NO IlaaHISNOD WRH <br />MANIFEST # 3 5 <br />OT90 ZE6 60Z XVH 66:ZT 8002/V0/ZO <br />