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❑ Keller Canyon ❑Coffin Butte ❑Ox Mountain" ❑Newby Island Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sane ''y Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Bu Roao 1,2310 San Mateo Road 1601 E]TiCon 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)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> I <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Spreckels <br /> MAILING ADD ESS _ <br /> 20500 SO-96 Ho-ft Dive 9905 <br /> CITY, STATE, ZIP " :% REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ThmMCA 95304 <br /> PHONE LXGLOVES ❑ GOGGLES ❑ RESPIRATOR 30 HARD HAT i <br /> C]TY-VEK XSAFETY VEST <br /> C N ACT PERSON <br /> eC1 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 properly �(•-. r <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 RECEIVING FACILITY <br /> .,.acrordance.with the.requirements.of40,CER,P.art268 and,is,no longer a hazardous waste as defined by <br /> 40 CFR Part 261. - <br /> WASTE TYPE: <br /> MAI ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD _ <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY - - <br /> 20500 South Holly Dive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS— <br /> Rod Off icy <br /> C <br /> C T ATE, PEmdi-CA 95241 <br /> z <br /> PHONE __BOTTOM.-DU.ME� __ TRANSFER. <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE LL-OFF FLAT-BED VAN DRUMS <br /> ❑ O ❑ 0 <br /> Ar/ <br /> CUBIC YARDS <br /> W I hereby certify that the above named material has been <br /> accepted and to the best Of lily knowledge the foregoing pjSP0541_METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> DEBRIS <br /> FACILI TICK T NUM gR ❑ ON RIABLE s <br /> 1 ASS TOS ; <br /> SIGN URE HORIZEErAJENT I XDAA <br /> WO D <br /> ❑'ASH <br /> r ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MAdfi PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LQADS ARE SUBJECT ; <br /> TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST 0,Rev 11109 NS-024 GENERATOR Co,PY;. <br /> # <br /> • 1 <br />