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K,.`, y7;_ eller Canyon- Coffin Butte ❑Ox Mountain ❑ Newby Is Forward <br /> Sanitary Landfill Landfill Sanitary Landfill San" ''y Landfill Landfill <br /> 901 Bailey Road 28972 Coffin B oad 12310 San Mateo Road 1601 LixCn 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 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)96271'009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE TOR J WASTE ACCEPTANCE NO. <br /> MAILIJI)PI <br /> 4PDRES,S. <br /> O <br /> CITY;,,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CI GLOVES ❑GOGGLES ❑'RESPIRATOR HARD HAT <br /> y PHONE <br /> at -7 2 [� f 0 TY-VEK ❑SAFETY VEST <br /> X <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 material is not a hazardous . <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste Ise treatment residue of a'preblously restricted hazardouswaste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY /J <br /> accordance with the requirements of 40 CFR Part 26hazardous wase as ed <br /> 6 and is no longer a hazardtdefined by - <br /> ----- -AO CFR'Part 261':" _. _. -. .. .._. .. .: - - -. <br /> WASTE TYPE. <br /> 13 DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD �- <br /> ❑DEBRIS '90TH R <br /> O SPECIAL WASTE <br /> GENERAT GFACILITY _ Q o <br /> TRANSP .R f NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRES1� <br /> CITY, STATE,,ZaP <br /> __._- -_.-. -----: - "-- --------------.---•---"__---END_ MP-__--_-m_ _B0TTOM.DUMP- . TRANSFER <br /> PH. <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE :RQEL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> - CUBIC YARDS <br /> _--I hereby certify that the above named Mateiial has been <br /> accepted aid t0 the best of my knowledge the foregoing DISPOSAL METHOD: . (TO BE COMPLETED BY LANDFILL), <br /> is true and accurate. <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL - <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER / I DEBRIS <br /> 0 NON-FRIABLE <br /> I 1 I /1 ASBES OS: . <br /> SIGNATURE OF AUTHORIZED AGENT ! / DATA / <br /> WOO f <br /> �q�1$H <br /> uLSPEC L OTHER = <br /> SCHEDULING MUST BE MADE PRIOR TO-3:006 P.M.TAE AY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE,SCHEDULED•WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST <br /> GENERATOR COPY <br />