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LJKeller Canyon, ❑Coffin Butte ❑Ox Mountain ❑Newby Island Forward nm4 ., <br /> r� I <br /> Sanitary Landfill Landfill ,� Sanitary Landfill Sam "lry Landfill Landfill <br /> -t. 901 Bailey Road 28972 Coffin e.Road 12310 San Mateo Road 1601TJixan Landing Road9999 S.Aust <br /> in Road �£ <br /> r4. Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)4584800 Phone(541)7452018 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)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> 4;. <br /> GENERATOR �� r WASTE ACCEPTANCE NO. f <br /> MAILING ADDRESS <br /> 05, <br /> h CITY;STATE,ZIP 'REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ! U GLOVES. ❑GOGGLES D RESPIRATOR.,. ARD NAT 1 <br /> 011 ❑TY-VEK El SAFETY VEST . <br /> CONTACT PERSON / <br /> c- <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE-OF-AU OREZED' UTJ: TLE DAT /} v <br /> 0A.) <br /> * �I VZ /� b_- 461 <br /> 5k <br /> GENERATQF'Y' ERTI,$CATION:I h reby certify 91he above named material is nothazardou <br /> `waste ash eti ed by 40 FR Part 261 or title 22 of a California code of regulations,has been propes <br /> rty <br /> dascribgd,yYassified a d packaged,and is In pr r condition for transportation a-tording to applicable <br /> regulal on ;AND,It th waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the land Dis osal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> --accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by,: _ <br /> 40 CFR Part 261. x <br /> WASTE TYPE: / / '1 = ►' i <br /> SID CONSTRUCTION 0 WOOD --- — �- <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE I, <br /> GENERATING FACILITY ,O G t, <br /> TRANSPORTERNOTES.'` VEHICLE LICENSE NUtu4BE91' _ :TRl1CKNUMBER <br /> ADDRESS I y[--/ -� ': �-P <br />' CITY,STATE,ZIP d^3 ! !�''e-- <br /> PHONE- <br /> -PHONE --END-DUMP ` -----BOTTOM'DUMP-- ._.:__.TRANSFER <br /> ❑ I <br /> SIGNATURE OFAUTHtORIZED AGENT OR DRIVER DATE - RCR-_C=OFF(S) FLAT-BED VAN DRUMS <br /> A CUBIC YARDS ' 77 <br /> hereby certify that the above'named material has been <br /> acce <br /> .0tey and to the best of my knowledge the foregoing . <br /> DISPOSALMETHOD: (TO B!=COMPLETED BY LANDFILL) x <br /> is true and accurate t <br /> i kir DISPOSE y OTHER ✓ h <br /> I ; <br /> REMARKS C]SOIL <br /> - -0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> I O ASBESTOS LE <br /> yr <br /> .- I <br /> SIGNATURE OF AUTHORIZED AGENT - ATE rr j <br /> 0 W OD i <br /> QA <br /> S{H <br /> s <br /> Q SPECIAL OTHER s a <br /> i .. � . <br /> SCHEDULING MUST BE MADE PRIOitT. 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY IJHSC HDULED.LOADS ARE SLI6JECT <br /> } REFUSAL UPON ARRIVAL. ONGOING_DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE; � I <br /> i GENERATOR COPY <br />