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❑Keller Canyon []Coffin Butte ❑Ox Mountain ❑Newby Island Forward <br /> Sanitary Landfill Landfill { a Sanitary Landfill Sr'� ,�`nary Landfill ' Landfill - <br /> 901 Bailey Road 28972 Coffin e Road 12310 San Mateo Road 1601 "'n 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 Prone (209)982=4298 F <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 WASTE ACCEPTANCE NO. <br /> Spreckels Suaniri <br /> MAILING ADD ESS _ � <br /> 20500 Soulk HOUV Drive <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Tnwy CA 95-M4 <br /> PHO lW ERGLOVES C] GOGGLES C1RESPIRATOR ]p HARD HAT <br /> t <br /> ❑TY-VEK EXSAFETY VEST <br /> C N ACT 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 regulaticns,has been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulaVons;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 En RECEIVING FACILITY <br /> accordance with the requirementscf 40 Fn Earl 268 and is no longer a hazardous waste as defined by - <br /> 40 GFR Part 261. <br /> It <br /> WAST PE: /.. <br /> C1061SPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD _ R <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY " <br /> 20500 Soulb Hoer Drive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ran U0oil 1= <br /> ADDRESS Pod offim IQ <br /> i Q <br /> C <br /> 41 <br /> PHONE _,, r, ..�:�. ._ _ __�_ _ _- __END_DUMP -- .---_BOTTOM._DUMP_ TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ © ❑ <br /> CUBIC YARDS <br /> ^I 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 /> • <br /> REMARK ❑ SOIL � <br /> � <br /> ❑ CONSTRUCf ION <br /> DEBRIS <br /> FACILITY TICKET NUMBS El NON FRIAB 1; <br /> ASB STOS <br /> SIG ATURE `F gUTH I�IZE lAG�NT �-� bA <br /> y W0 D <br /> A. AS <br /> 0. <br /> 5PE IAL'AER <br /> SCHEDULING MUST BE MADE PINGOING <br /> R TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVALDAILY DELIVERIES MUST BE..SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br /> Rev 11!09 NS-024' :,:GENERATOR COPY MANIFEST# <br />