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LJKeller°,.Canyon ❑Coffin ❑Ox Mountain <br /> Sanitary.Landfill Landfill . . .Newby island Forward <br /> Sanitary Landfill S� �`ary Landfill Landfill <br /> } 901 8aifey Road 28972 Coffjn tte Road 12314 San Mateo Road <br /> . Pittsburg, CA 94565 Cofvallis, OR 9733Q 160 "bixon Landing Road 9999 S. Atist1 Rad <br /> f Phone (925)458 9800 Phone 541 745 2018 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 9'�3 6 <br /> ( ) Phone.(650) 726-1819 Phone (408) 945-2800 Phone (209) 982-4298 <br /> Fax(925)458-9891 Fax(541)'745-3826. Fax(650) 726-9183 Fax(408)262-2871 Fax(209) 982-1008 <br /> :; y::- <br /> " r'hbN-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> 6 s WASTE ACCEPTANCE NO. <br /> fVAILING ADDRESS <br /> '205 CO.8� Holly. e <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> '€�cv� 'A 553 <br /> PHONE ". 1GLOVES Q GOGGLES U RESPIRATOR M HARD FIAT <br /> - CONTACT PERSON <br /> ❑TY-VEK aSAFETY VEST <br /> SPECIAL HANDLING PROCEDURES- <br /> SIGNATURE OF AUTHORIZED AGENT-/TITLE DATE r <br /> 1k <br /> r. ,$ <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> =s waste'as defined by 40 CFA Pan 261 or title 22 of the California code of regulations,has been properly r <br /> deschhed,classified and packaged,and is in proper:eorid;Von for transportation according to applicable, <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste'!' - - <br /> "' subject to the Land Disposal Restrictions,I cerdfy and warrant that the waste has been treated in <br /> - ._aocordancewiihlhe,requiremenis,of-40.CFR.P..art268and.isnolongera.hazardouswasteasdefinedby,,, RECEIVING FACILITY <br /> 40 CFR Pan 261: _,. . -, ..,. <br /> UVASTE,. YPE <br /> El LI)r)GF <br /> ❑CONSTRUCTION ❑WOOD <br /> Q DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> Y + TRACY <br /> TRANSPORTEFV_• NOTES: VEHICLE LICENSE NUMBER TRUCK`NUMBER <br /> ADDRESSlee <br /> 4 <br /> a CITY,-STATE.,JP <br /> u <br /> PHONE,.w�,d --E-ND-DUMP--- SpTfOM=DUMP— TRANSFER <br /> � - - ate• 0 � • <br /> SIGNATURE OF AUTHORIZED AGENT-OR DRIVER DATE .,ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> Cy <br /> * W <br /> �• CUBIC YARD <br /> 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 /> DISPOSAL METHOD .(TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER. <br /> REMARKS <br /> o Sar._ <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT. DATE <br /> 0 WOOD <br /> f� ❑ ASH <br /> *. <br /> 7,110 <br /> O SPECIAL OTHER <br /> j <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL o ANIY UNSCHEDULED LOADS ARE SUBJECT Fj. <br /> t . TO REFUSAL UPON ARRIVAL.'ONIGOING DAILY.DELIVERIES MUST BE SCHEDULED WITH THE LANIDIFILL"THIS DAY BEFORE. <br /> Rev 11/09 N.S 024 MANIFEST <br /> TRANSPORTER COPY <br /> # <br />