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f L7 Keller Canyon <br />i Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />❑ Coffin E <br />❑ Ox Mountain <br />❑ V )y Island <br />Landfill <br />Sanitary Landfill <br />Sa,atary Landfill <br />28972 Coffin Butte Road <br />12310 San Mateo Road <br />1601 Dixon Landing Road <br />Corvallis, OR 97330 <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 />NON -HAZARDOUS <br />WASTE MANIFEST <br />;-Forward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />- ••�• ......� avrvry #%MMIVAL. UNc;vING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br />GENERATOR COPY MANIFEST # J <br />600[n NOIISIA1I,LSNOSI UVH OT90 Z£6 60Z YVA Sb:ZT 800Z/tO/ZO <br />GENERATOR 00WASTE <br />ACCEPTANCE NO. <br />C <br />MAILING ADDRESS <br />30 Cf/) <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />b /tI toe <br />CITY, STATE, ZIP <br />GLOVES Cd'I;OGGLES to 1ESPIRATOR 70 HARD HAT <br />VEK Q SAFETY VEST <br />PHONE -, <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHO I D AGENT / TITLE <br />DATE <br />GENERATOR'S CERTIFICATION: I hereby certity that the above named material is not a hazardous <br />waste as defined by 40 CFA Parr 261 or title 22 of the Caldomia code of regulations, has been property <br />dsxsibed, classified and packa0ed, and is in proper condition for transportation a -cording to applicable <br />reguiatbro; AND. If the waste Is a treatment residue of • prrviousty restricted hezardous waste <br />subject to the Lard Disposal Restrictions, I certify and warrant that the waste has been treated in <br />accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br />40 CFR Part 261. <br />RECEIVING FACILITY <br />WASTE TYPE: <br />DISPOSAL U SLUDGE <br />CONSTRUCTION U WOOD <br />DEBRIS U OTHER <br />U SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />/,5 <br />ADDRESS <br />n <br />CITY, 6TATE, ZIP <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />_, <br />A AUTHORIZED AGENT OR DRIVER DATE <br />* <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 />❑ <br />ROLL -OFFS FLAT-BED VAN DRUMS <br />�2� ❑ ❑ ❑ <br />CUBIC YARDS <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />U SOIL <br />EMARKS <br />U CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />, <br />U NON -FRIABLE <br />ASBESTOS <br />SIGN A RE OF THORIZED AGENT <br />DATE <br />U WOOD <br />U ASH <br />U SPECIAL OTHER <br />ARRIVot a ANY <br />I INCCLICni 11 cn I <br />nA F% A or CM sm rrr^ r <br />SCHEDULING MUST BE MADE PRO RTO 3.00 P.M.THE DAY PRIORTO <br />EXPECTED <br />- ••�• ......� avrvry #%MMIVAL. UNc;vING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br />GENERATOR COPY MANIFEST # J <br />600[n NOIISIA1I,LSNOSI UVH OT90 Z£6 60Z YVA Sb:ZT 800Z/tO/ZO <br />