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❑ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island �Orward <br /> B� <br /> Sanitary Landfill Landfill Sanitary Landfill Sa ry Landfill fLandfill <br /> + <br /> 901 Bailey Road 28972 Coffin Road 12310 San Mateo Road 1601 Titxon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97,336 Haff Moon Bay,CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone (925)456-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax`(660)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> 11d.— a <br /> NON-HAZARD_OUS"WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, P C. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Y. <br /> PHONE LOVES U GOGGLES . ❑RESPIRATOR ARD HAT <br /> .. <br /> £ 0 TY-VEK .aIS'AFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT./TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named materia not a hazardcus <br /> waste as defined by 40 CFA Part 261 or title 22 of the Califomia code of regulations,has been property , <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable :k <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazerdous waste ell i <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> rt RECEIVING FACILITY ' 't <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 GFR Pa261. <br /> WASTE TYPE: <br /> �U CONSTRUCTION U WOOD <br /> .Q DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER .. NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> tN <br /> ADDRESS 10 <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVE DATE ROL -OFF(S) FLAT-BED VAN DRUMS <br /> e <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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> _ <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> -, a CONSTRUCTION <br /> FACIL,ITYTICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASE(ESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DA <br /> D <br /> f <br /> �. U SPECIAL,OTHER <br /> SCHEDULING MUST BE MADE P 1ORTO 3:04 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> r <br /> TO REFUSAL UPON ARRIVAL_/ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> i TRMANIFEST 1k 97736 <br /> 7736 <br /> �..._. .cntcanFrz'r=ra rnpv <br />