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- <br /> Kollor Canyon 0. cuff n Bette - <br /> X mountalin n Newby Island <br /> Sanitary Landfill Landfill �� _ y �Forward <br /> Sa��itsry Landfill Sa, �ry Landfill � Landfill <br /> go! n0gy Rom 2007P Ga(Ir� a floe IP8110 Sgh MA160 road 1�A�"r�xbn I,�nclin <br /> PI11sburg, CA 94505 CONA111S, OR 97330 1�aif Moon gay, CA 94019 Milpitas, CA 95035 Road 0999 S, Austin Hoad <br /> Phone (925) 458-9800 36 <br /> Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 8234298 <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 /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> M ILfNG ADD ESS <br /> 20500 Souls Ho&Drive — 9905 <br /> C17Y, STATE, ZIP EEI <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CA 95304 <br /> PHONE XGLOVES ❑ GOGGLES ❑ RESPIRATOR M HARD HAT <br /> CONTACT PERSON LJTY-VEK CXSAFETY VEST <br /> Anne QM SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 8 <br /> k <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 properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulaVans;AND,If the waste is a treatment residue of a previously restricted hazardous waste r ri <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> _accordance with th_e requirements of 40 R Part 268 and is no longer a hazardous waste as defined by - <br /> 40 CFR Part 261 - - ..- <br /> 1 <br /> WASTE TYPE: <br /> ISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD - - <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20300 South Holly Drive TRACY � <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> ITY, T <br /> 1­9 CA 95241 <br /> PHONE_ ,. ----------_ _ ____EN© DUMP__ BOTTOM_DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> s, - <br /> -- -- - <br /> 1 hereby certify that the aboi►e_named Materiah has been <br /> accepted and to the best of my knowledge the foregoing r . <br /> is true and:accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) �{ <br /> DISPOSE OTHER =4 '` <br /> ' REMARKS O SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY ET NUMBER DEBRIS <br /> I ❑ NON-FRIABLE <br /> ASB TOS t <br /> SIGNA URE' F AUTHO .rZED_.QGENT AT L1 WOO <br /> �. :❑ ASH <br /> ❑ SPECIAL OTHER. <br /> SCHEDULING MUST BE MADE P tOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUB '- / <br /> TO REFUSAL UPON ARRIV! .ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BF, <br /> Rev 11109 NS-024GENERATOR COPY j MANIFEST# -� ��` <br />