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Li nerler Lanyon L1Coffin Butte ❑Ox Mountain ❑Newby Island Q Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sr"'`ary Landfill Landfill E <br /> 901 Bailey Road 28972 CoffinWe Road 12310 San Mateo Road 160TDixon Landing Road 9999 S. Austin Road <br /> Pittsburg, CA 94565 Corvallis,OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 ' Manteca, CA 95336 <br /> Phone(925) 458-9800 Phone (541) 745-2018 Phalle (650)726-1819 Phone (408) 945-2800 Phone(209) 982-4298 <br /> Fax(925)458-9891 Fax (541)745-3826 14 Fax(650)726-9183 Fax(408) 262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST I <br /> t <br /> GENERATOR <br /> WASTE ACCEPTANCE Ni <br /> MAILING ADD ESS <br /> 20500 Souffi Holly Drive99in <br /> MW <br /> CITY, STATE, ZIP.CA 95304 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE CXGLOVES ❑ GOGGLES ❑ RESPIRATOR X HARD HAT M <br /> ❑TY-VEK JESAFETY VEST <br /> COM ACT PERSON f' <br /> ..Aisne D SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> /U <br /> 1 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above n reed material is not a hazardous <br /> waste as defined by 40 CFA Part 261 or title 22 of the CaEifornia code of regulations,has been properly .I <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste Is a 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' t <br /> —_ .-accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as definedby RECEIVING FACILITY - <br /> 40 CFR Part 261. <br /> WASTE PE: <br /> SPQSAL ❑SLUDGE I <br /> ❑CONSTRUCTION ❑WOOD -- <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 SoWh Hotly Drive TRACY <br /> TRANSPORTER NOTES: VEHICLE WCENSE NN MBE TRUCK.NUMBEIR <br /> ADDRESS20A f-ti Reim 3 V7 <br /> CITY, STATE, ZIP <br /> LoQdiCA 0241 <br /> PHONE-__._.— r _�_-.m .N_-- _..---_--�� —END DUMP ----BOTTOM DUMP ---.TRANSFER <br /> ❑ ❑ .. <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE LL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC:YARDS <br /> hereby certify that the ablove timed material has been <br /> accepted and to the best of m knowledge the foregoing <br /> is true and accurate. DISPO ETHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ' ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TI%KET NUMBER DEBRIS <br /> ❑ NON-FRI BLE <br /> AS EST S <br /> SIGNATUFfEliOF AUTHORI , D &GENT DAIS <br /> - / ❑ W OD I <br /> ❑ A H I <br /> ❑ SPECIAL OTHER <br /> SCHEDULING M TBE MADE PR OR O <br /> 3;00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVALOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE-LANDFILL THE DAY BEFORE._ i <br /> Rev 11/09 N5-024 ���f// GENERATOR-COPY MANIFEST# 6 4. <br />