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LJ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Landfill ' <br /> Sanitary Landfill Sa � �ry Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Buf�e Road 12310 San Mateo Road 1601-[1xon Landing Road 9999 S.Austin Road <br /> Pittsburg. CA 945F5 Corvallis, OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone(925)458-9800 Phone(541)745-201.8_ Phone (650) 726-1819 Phone(408)945-2800 Phone(209)982-4298 k <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 /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADD S ,„► e <br /> CITY, STATE, 7 <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE LOVES D GOGGLES ❑RESPIRATOR ..6rHARD HAT, <br /> 77e--^' ❑TY-VEKAFETY VEST <br /> CONT T PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUT IZEb AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above med material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or titie 22 of the California code 01 regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to appficable <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Rettrictions,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 CFA Part 261. <br /> WASTE T E: ; <br /> - U SI >5-- <br /> O CONSTRUCTION G WOOD �.. <br /> a DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> '0.0 -4 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER- <br /> ADDRESS <br /> f "1 <br /> CITY,STATE,ZIP <br /> �. <br /> PHONE _ END,D BOTTOM DUMP TRANSFER <br /> J ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OFJ DRQVER ,,. DATE P,09LL-OFF(5) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS, rv.... <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 /> DISPOSE OTHER <br /> REMAFIKS <br /> Q solL <br /> ❑CONSTRUCTION <br /> M <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 ON-FRIABLE <br /> SBESTOS <br /> SIC-NATURE OFP.t THORIZEDAGENT r TC/-- I <br /> C] OOD j <br /> s /A <br /> C]ASH <br /> i U SPECIAL OTHER , <br /> SCHEDULING MUST SE MADJPRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCkI1FrDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIV L. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL.THE DAYBBEFOeRE. <br /> - r n MANIFEST q 7 t *1J <br />