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''❑ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island A-FQru„ard <br /> Sanitary Landfill Landfill Sanitary Landfill Sal dry Landfill <br /> Landfill '� t <br /> 901 Bailey Road 28972 Coffin Bure Road 12310 San Mateo Road 1601 on Landing Road 9999 S."Austln'Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca CA953361 <br /> Phone(925)458-9800 Phone(541)*45-2018x- Phone(650)726-1819 Phone(408)945-2800 Phone(209)962-. <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 '•': : <br /> NOWHAZARDOUS WASTE MANIFEST <br /> GENERATOR �J <br /> !t-C. � j.C.•t_. WASTE ACCEPTANCE N0. <br /> µ MAILING ADDRESS' J, <br /> . : � <br /> CITY,STATE,ZIP - f /. . aj - 7 REQUIRED PERSONAL PROTECTIVE EQUIPMENT, <br /> PHONE R ► �� i '� �. 0 GLOVES 0 GOGGLES O RESPIRATOR �HARD HAT <br /> 0._13 7— / f D TY VEK O SAFETY VEST <br /> CONTACT PERSON , r° _ <br /> = . � �� ---V/V .-:_ SPECIAL HANDLING�'ROCEDURES:�;� <br /> p }�'r = �r �ws� / i <br /> SIGNATURE OF AUT}iORIZED AGENT_I TITLE.. { DATE t.:. <br /> GENERATOR'S`CERTICATION:t h�reby cartity.th ithe above named material is not hazardous <br /> waste as�deflnad by 40 FR Part 261 or title 22 or Fie California Code of regulations,has been properly <br /> described,_plassified d packaged,and is in propbr condition for transportation a eprding to applicable 7. <br /> regulations;AND,If ft waste Is a treatment residue of a previously restricted hazardous waste <br /> ,,subje@t to_the Land_pisposal stri <br /> Rections,I certify and warrant that the waste has been treated in t".. RECEIVING FACILITY <br /> accordance with the req"wre`ments of'40 CFA Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261.' <br /> WASTE`fYPE. __5-?)/ <br /> DGE -- <br /> ❑CONSTRUCTIOf�f, 0 WOOD <br /> ❑DEBRIS _ . ^ .0 OTHER <br /> ❑SPECIAL WASTE '- - <br /> GENERATING FACILITY Q , U /`� <br /> ✓ ' <br /> HI LE LICENSE NUMBER TRUCK NUMBER <br /> TRANSPORTER ,, r/ f > NOTES: VE G p <br /> ADDRESS . <br /> _5 �, ! <br /> CITY,STATE,-ZIP ;{ <br /> PHONE, 77 `"' - `- .----END-DUMP - BOTTOM DUMP__.__ __'TRANSFER. . <br /> r';i �.i r <br /> U i <br /> .�v SIGNATURE OFAUTIiORI ED AGENT OR DRIVER DATE. ., . ROL'L"I-�OFF(S) ;' FLAIT�-BED VAN DRUMS <br /> .,.. .._ -�. ..,L - w...,....-....,... - T _ .. <br /> CUBIC YARD,,S <br /> A, I <br /> hereby certify that the above named material has been <br /> acceote and t0 the.best of MV'knowledge the foregoing DISPOSAL METHOD: (TO BE.COMPLETED BY LANDFILL) <br /> 1� <br /> --- is true and accurate. 4r <br /> DISPOSE OTHER <br /> ❑SOIL <br /> REMARKS t` <br /> ❑CONSTRUCTION -... <br /> DEBRIS <br /> '= FACILITY TICKET NUMBER iD NON-FRIABLE <br /> {AS16ESTOS <br /> SIGNATURE OFAUTHORIZED AGENT, DATE; r t <br /> � s � � <br /> fCtl <br /> fAS oD <br /> E * <br /> Q SPECIAL OTHER <br /> SCh3EQ,ULiNG:MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT " <br /> TO REFUSAL3IJPON ARRIVAL, ONGOING'DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE i <br /> ` ' TRANSPORTEFi'GC)PY <br /> MANIFEST# sed ibi' <br />