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{ i,UKeller Canyon' ❑Coffin:Butte. E1.0x Mountain 1 <br /> Newby Island ( Forward <br /> �. = ,Sanitary Landfill Landfill , ' Sanitary Landfill Sant Landfill Landfill <br /> f 901 BaileyRoad <br /> I 2$972 Coffin-butte Road 3r• 12310 San Mateo Road .1601 Dixon Landing Road 9989 S.Austin Road <br /> Pittsburg, CA 84565 Corvailis;OR 97330 Haff Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CAE8229)Phone (925)458-9800 Phone (541)745-2018 .. Ph6ne(650) 726-1819 Phone (408) 945-2800 Phone(209)°'� Fax(925)458-9891 Fax (541)745-3826 Fax (650)726-9183Fax(408)262 2871 Fax(209)98 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> kwhk '- WASTE ACCEPTANCE NO. <br /> MAILING'ADDRESS <br /> 20500 South�iol�Da�erc — 9 <br /> CITY,STATE, ZIP ° REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> •� 95304� <br /> PHONE ENGLOVES ❑ GOGGLES ❑ RESPIRATOR X HARD HAT <br /> - - <br /> 2093$34-7M ❑ TY-VEK CKSAFETY VEST <br /> CONTACT PERSON_.` - <br /> Cp" SPECIAL HANDLING PROCEDURES: i <br /> SIGNATURE.OF AUTHORIZED AGENT/TITLE DATE <br /> Alert- <br /> ,a * �. r <br /> GENERATOR'S CERTIFICATION:f hereby certify that the above named material is not a hazardous <br /> waste as defined by 44 GFA 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 toapplicable i <br /> regulations;AND,If the waste is treatment.residue of a previously restricted hazardous waste + <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> --accordance with the°.requirements of 40 CFR P 68 and.is.ne longera hazardous waste as defined by'--- -- _ - - <br /> 40 CFR Part261.' , <br /> WASTE TYPE: " ` <br /> E --Q-&LL DQE <br /> ❑CONSTRUCTION ❑WOOD ". .,. �. .. <br /> ❑DEBRIS O OTHER <br /> ❑SPECIALWASTE <br /> yA <br /> GENERATING.FACILITY ~ <br /> 20.50-90u*'KAY DdVeC <br /> TRANSPORTER- ' NOTES: VEHICLE LICENSE NUMBER` TRUCK NUMBER <br /> inn DPOLC 09 to_% `7 <br /> ADDRESS 4 &'Pod offier ho�1,507 <br /> . <br /> CITY; STATE,ZIP.: <br /> 1,O&CA 05241 <br /> r PHONE __T..-- --END-E?UMP-' _`- .BOT-TOM HUMP-: 'kANSFER <br /> ._�... ..,f ,. <br /> 0 , J _ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED: V,�, ; ! . .,.DRUMS <br /> CUBIC YARDS <br /> �I hereby certify that the above named material: has been <br /> ' accepted and to the best of my.knowledge the.foregoing DISPOSAL METHOD'. (TO BE COfvIPLETED.BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE .OTHER <br /> - ❑ SOIL I ; <br /> REMARKS r''�^, t._/ <br /> ❑ CONS RUCTION <br /> FACILITY TICKET NUMBER` ` ..., DEBRIS '/ i <br /> I❑ ON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE.OF AUTHORIZED AGENT DATE <br /> L ❑ WOOD <br /> ❑ ASHS <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR,TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE.SUBJECT. 4 <br /> TO REFUSAL UPON,ARRIVAL.ONGOING DAILY'DELIVERIES MUST BE SCHEDULED.W11TH THE LANDFILL THE DAY BEFORE. <br /> *v 11109 NS-024 �: TRANSPORTER COPY MANIFEST# �. <br />