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1 <br /> ❑Keller Canyon ❑Coffin Butte El Ox Mountain ❑Newby Island Z]FOrward <br /> ' Sanitary Landfill Landfill Sanitary Landfill Sanitary 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 94585 Corvallis,OR 97330 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Ptxpne(641)745-2018 Plane(850)726-1819 Phone{408)945-2600 Phone(20%982-4290 <br /> ' Fax(925)458-9891 Fats(541)745-3826 Fax(650)728-9183 Fax(406) Fax(209)982-1009 <br /> NOR!-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MW,LP.Kinder M:rrm <br /> ' MAILINGADDRESS _ r' <br /> 1. <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> - <br /> PHONE GLOVES O GOGGLES D RESPIRATOR T5HARD HAT <br /> (91 11)6.1 - 'i OTY-VEK CWSAFETY VEST <br /> CONTACT PERSONStera10 can SPECIAL HANDLING PROCEDURES: - <br /> SIGNATIf OF AUTHORIZED AGENT I TITLE DATE <br /> - <br /> GEWRATOF11b CEAnnIs CXFCJ lhereby,at*that tneabbo lawn saarbtw We hazardous <br /> Wmb as ns M to Q CFR W 261 cr b9s 2201 the.',.aldashaC ad raadalkAs,has both Plgady <br /> davn'bed,e %sd end packaged.and Ahpnpur Mnessen!a bahspeneelana'Carnes b applkabn <br /> 1p,wmin:aR0.a efe win Is a Iraalmam residua al a Prabwq rnukw Irsndeua Wmb <br /> ' sugxln4w tarp Cipaaal Raaaledpd.l<ahzy arab wanantblY"wasnInes,ban basted le RECEIVING FACILITY <br /> auvdarcew. MlpWamnsdad CFA Part 266 stable MOWnWaaaiardpuswmn as dshlMry <br /> ap CFR Pan 261. - <br /> WASTE TYPE: ---------_ _.. -._ - <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD _ <br /> ' O DEBRIS OOTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY --- -- <br /> 3851SouthWhisrry3lhx*R4 HOLT —. - -- .-_ -- <br /> tTRANSPORTER NOTES:, '✓erICLE LICE'S--N--BEP; TRUCK NUMBER <br /> NRC.Frrvirmner6nl ut rvim <br /> ADDRESS LC 7 Z Z C7 <br /> ' CITY.STATE,ZIP - <br /> AlanerdafA 94501 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ( 3 <br /> GNATU EO AUTHORIZED AGENT OR DRIVER IDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> ' 1 hareby 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 /> REMARKS — O SOIL <br /> O CONSTRUCTION <br /> DEB' <br /> FACILITY TICKET NUMBER NON FRIABLE <br /> ASBSTOS <br /> E <br /> SIGNATURE OFAUTHORIZED AGENT DATE <br /> O WOOD <br /> t O ASH <br /> �.__—_—._. __—_ __- ❑SPECIPL O:MEF:. <br /> ' SCHEDULING MUST BE MADE PRIORTO 3:00P.11.TI,F0,kf fAiGH TO EXPECTEDARRIVALANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> LANDFiLL COPY MANIFEST 4 699358 <br /> 1 <br />