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D Keller Canyon yam` Coffin B ixte,"' EI-Ox Mountain -E]Newby Island , Forward <br /> Sanitary Landfill � andflll Sanitary Landfill c�` Mary Landfill Landfill <br /> 901 Bailey Road 28972 Coffi�ttO'Road 123�O;Sdh Mateo Road - 16171`Dixon Landing Road 9999 5. A tPadPittsburg, CA 94565 Corvallis,OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 .Manteca, APhone (925)458-9800 Phone`(541) 745-2018 Phone (550) 726-1819 Phone(408) 945-2800 Phone (2� <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 <br /> Fax (209)982 1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> sum <br /> MAILING ADDRESS 9905 <br /> — <br /> 205M get HODY]fie <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> T •CA 93304 C LGLOVES 0 GOGGLES d RESPIRATOR . ID HARD HAT <br /> PHONE I <br /> 7 O TY-VEK. [ LSAFETY VEST <br /> 09)134: 679 <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES:Aiine <br /> " <br /> 7 <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> C ' GENERATOR'S CERTIFICATION:I hereby certify that the above named Aierial is not a haiardous <br /> f waste as defined by AO CFR Part 261 or title 22 of the California code of regulations,has been properly <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'Restr cions,I certify and'warrant that the waste has been treated in - - RECEIVING FACILITY <br /> -. ""accordance`withtbe requirement 40 CFR:Pert 268 and is no longer a hazardous waste.as defined. <br /> by -- _ <br /> t 40 CFR Part 261 <br /> WASTE TYPE <br /> SP L 9-SLUDGE <br /> O CONSTRUCTION 0 WOOD: <br /> ❑DEBRIS ....D OTHER` <br /> ❑SPECIAL WASTE' <br /> GENERATING FACILITY <br /> ... <br /> =WSoiM Popsy DriftTRACY s . <br /> TRANSPORTER NOTES: VLHICLE'LICEN3E.NUMBEF 1 •: TRUCK NUMBER x <br /> _ <br /> ADDRESS. <br /> "Pad office Rem-4 S_-_T A <br /> CITY,STATE,-ZIP <br /> Lg&CA . .241 i <br /> PHONE ..tom_ r � _,��,_ r __END_DUMP __:_.BO1T0 <br /> ❑M_DUMP___ TRA©FER I <br /> ` SIGNATURE OF AUTHORIZED AGENT OR DRIVER: DATE ROLL-OFFS FLAT-BED, VAN DRUMS <br /> \4. CUBIC YARDS <br /> I <br /> I hereby certify that the above named material has been. <br /> _ accepted.and to the best of my knowledge the.foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE, OTHER <br /> C] SOIL <br /> REMARKS 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TI; KET NUMBER 0 NON-FR' BLE' <br /> ASB ST <br /> S <br /> SIGNATUFJIE OFA THORIZE AGENT DA E <br /> C1 OD <br /> SH <br /> SPECIAL OTHE <br /> t 1 <br /> SCHEDULING MUST BE MADE PRIOR TO 3:9b P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TOJR_ U AL UPON ARRIVAL.ONGOItXG DAILY DELIVERIES MUST BE SCIiEDULIED WITH THE LANDFILL THE®AY BEFORE <br /> _ p <br /> M 'ANIFEST# <br /> � <br /> r Rev tt/09 .. NS-024 a . :. TRANSPORTER.COPY „_; <br />