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I LJ Keller Canyon LJCoffin Butte., ❑Ox Mountain ❑Newby island Forward <br /> I Sanitary Landfill Landfill'' Sanitary LandfillS, �tary LandfillLandfill 901 Bailey Road 28972 COffl ... tte Road 12310 San Mateo Roar! 1 Fitrr�Llixon Landing Road 9999 S.Austin Road <br /> =a` 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)982-1009 <br /> E Nd~.N-HAZARDOUS WASTE MANIFEST <br /> GENE'f3ATOR, , , (' . WASTE ACCEPTANCE NO. i <br /> i <br /> MAILING%DDRESS <br /> C",STATE,ZIP j;' c REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONEJ U GLOVES .0 GOGGLES ❑RESPIRATOR BILI HARD HAT <br /> f ! <br /> ❑TY VEK U SAFETY 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 material is not a hazardous <br /> waste as defined by G0 CFR Pad 26 1 or title 22 of the California code of regulations,has been properly f <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable - , <br /> regulations:AND,It the waste Is a treatment residue of a previously restricted hazardous waste - <br /> subject to the Land Disposal Restrictions,l certify and warrant that the waste has been treated in. - RECEIVING FACILITY <br /> _ _•accordance with the requirements of 40 CFR Part 298.and is no longer a hazardous waste as defined by jI ' <br /> 40CFRPart26Y ._u -- .....V __... ,• <br /> WASTE TYPE <br /> 0 DISPOSAL 0 SLUDGE v <br /> 0 CONSTRUCTION 000013 <br /> 0 DEBRIS p OTHER <br /> 0 SPECIAL WASTE <br /> GENE RATING.'FACILITY <br /> TRANSWFfT�R fj`" NOTES:' VEHICLE LICENSE NUMBER ?RUCIt NUMBER <br /> ADDRESS;, ' `~ <br /> CITY,STATE;,ZIP <br /> HQNE„- ERDDUM11_ _ B_O_TTOMDUMP ._- TRANSFER. <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE” <br /> ROLL-OFF(S) -FLAT-BED- VAN DRUMS ' <br /> .` - ✓t r ASia;."« ^d <br /> CUBIC YARDS <br /> l hereby certify that the above named material'has°been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY.LANDFILL)' <br /> is true and accurate. <br /> "DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS f <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS . <br /> F' r 0 NON-FRIABLE <br /> '� � ASBES;fOS <br /> SIGNATURE OFAUTHORIZEDAGENT I j ( DATE <br /> IZI WOOD( <br /> f " ! <br /> sH - <br /> t r f t OISPECItAL QTHE.R <br /> SCHEDULING MUST BE MADE PRIOR T6'3:06 P.M.THE PAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVIERIES MUST BE=S.CHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> �� $ <br /> TRANSPORTER COPY ` -,.�- MANIFEST# f <br />