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❑Keller Canyon ❑C16ffj n Butte_ ❑Ox Mountain ❑Newby Island .Forward <br /> Sanitary Landfill Landfill . Sanitary Landfill Sa% dry Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Roal r. 112310 San_ Mateo Road 1601 Ixon Landing Road 9999 S.Austin Ro <br /> r <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA95338 <br /> Phone (925)458 9800 Phone (541)745-2018 Phone(650) 726-1819 Phone (408) 945-2800 Phone (209) 982-42 8 <br /> Fax (925)458-9891 Fax(541) 7.45-3826 Fax(650)726-9183 Fax (408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> kmv_�*Ch slum <br /> MAILING ADDRESS <br /> 205M Soulk HORY D&e - <br /> CITY, STATE, ZIP °REQUIRED PERSONAL PROTECTIVE EQUIPMENT f <br /> Tra" ,CA 05304 CXGLOVES ❑ GOGGLES ❑ RESPIRATOR 3D HARD HAT i <br /> PHONE <br /> w ❑TY-VEK LXSAFETY VEST <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Anne, <br /> gMy <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material is not a hazardous T <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified arnd'packaged,and is in proper condition for transportation according to applicable T <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste :r <br /> Subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in ' <br /> -accordance with tie Yequirements'of 40 FR Part 268-and is no longer hazardous waste as defined by --- RECEIVING.FACILITY ' <br /> r 40 CFR Pail 261. - <br /> WASTE <br /> f36SA _ BC - <br /> CONSTRUCTION ❑WOOD 4 1 <br /> LI DEBRIS' ❑OTHER <br /> O SPECIALWASTE <br /> GENERATING FACILITY <br /> "500�Outh Hoft'Didve TRACY <br /> TRANSPORTER • a- NOTES: VEHICLE LICENSE.NUMBER .. TRUCK NUMBER. <br /> ADDRESS- <br /> Ravi <br /> « .' <br /> , 4 <br /> CITY, STATE, ZIP <br /> PHONE.---. _- ----_----END-- --- <br />