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Christina Carbaial - <br />❑ 1(Iler Canyon <br />❑ Coffin Butte <br />❑ Ox Mountain <br />❑ Newby Island <br />® Forward <br />S itary Landfill <br />90 Bailey Road <br />Landfill <br />Sanitary Landfill <br />Sanitary Landfill <br />Landfill <br />Pit i burg, CA 94565 <br />Ph <br />28972 Coffin Butte Road <br />Corvallis, OR 97330 <br />12310 San Mateo Road <br />Half Moon Bey, CA 94019 <br />1601 Oixon Landing Road <br />Milpitas, CA 95035 <br />9999 S. Austin Road <br />me (925) 458-9800 <br />F 25) 458-9881 <br />I <br />Phone (541) 745-2018 <br />Fax (541) 745-3826 <br />Phone (&50) 725-1 B19 <br />F?x (650) 726-9183 <br />Phone (408) 9452800 <br />Phone(209)982-4298Mant9336 <br />* I <br />NON <br />Fax (408) 262-2871 <br />Fax(209)982-1009 <br />daaeifietl antl packaged, and is in proper condition for trensporta8on a-oord M to appr AWO <br />toga; AND, If the waste la a treatment residue of a prevlouery restricted h—doue weate <br />-HAZARDOUS <br />WASTE MANIFEST <br />RECEIVING FACILITY <br />d0 C Pan a waste as dermad by <br />�c crvalUN <br />sCMtEDU <br />Fish„r <br />WASTE ACCEPTANCE NO. <br />MA ING ADDRESS <br />g� <br />CI STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />PH E <br />S GLOVES O GOGGLES O RESPIRATOR sb HARD HAT <br />CO ACT PERSON <br />O TY-VEK 6 SAFETY VEST <br />Rssnirx� <br />SPECIAL HANDLING PROCEDURES: <br />SIG ATURE OF AUTHORIZED AGENT/ TITLE DATE <br />* I <br />GEN TOR'S CERTIFICATION: I hereby cavity the he abo mod material is not a hazardous <br />defined by W CFR Pan 251 or He 22 of the C i code W reOuladoru, has been property <br />tl, <br />daaeifietl antl packaged, and is in proper condition for trensporta8on a-oord M to appr AWO <br />toga; AND, If the waste la a treatment residue of a prevlouery restricted h—doue weate <br />au b the Land Disposal Restrictions, I canny and warrant that the waste has been treated In <br />nce <br />it the requirements of 40 CFR Pan 208 and is no longer /lezertlous <br />RECEIVING FACILITY <br />d0 C Pan a waste as dermad by <br />WAS E TYPE: <br />ISPOSAL O SLUDGE <br />ONSTRUCTION O WOOD <br />O EBRIS O OTHER <br />O PECIAL WASTE <br />GEN RATING FACILITY <br />X95' U. AuAirt hced P�s43d: kJ: <br />NOTES: VEHICLE UCENSE NUMBER TRUCK NUMBER <br />TRA PORTER <br />FIs �i LatldEii <br />ADD SS <br />SS'Yd is Aintin F.oad <br />CITY, TATE, ZIP <br />PHO <br />rar .4Z� <br />END DUMP BOTTOM DUMP TRANSFER <br />SIGN URE OF AUTHORIZED AGENT OR DRIVER DATE <br />o <br />ROLLOFF S <br />FLAT-BED VAN DRUMS <br />® o © 0 <br />* — ii -6 or <br /><< <br />CUBIC YARDS <br />I hereby certify that the above named material has been <br />- <br />acc pted and to the best of my knowledge the foregoing <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />j is true and accurate. <br />j <br />DISPOSE OTHER <br />EMA KS <br />SOIL <br />O CONSTRUCTION <br />FACILI TICKET NUMBER <br />DEBRIS <br />O NON -FRIABLE <br />SIGNA RE RIZED AGENT DATE <br />ASBESTOS <br />O WOOD <br />1 <br />GASH <br />O SPECIAL OTHER <br />M BE RTO 3100 P.M.THE DAY PRIORTO EXPECTED ARRIVAL eANY UNSCHEDULED LOADS ARE SUBJECT <br />TO: REFU L UPO IYAL. ONGOING DAILY DELIVERIDES MUST BE SCHEDULED WITH THE LANDFILFILL COPY MANIFEST L THE <br />THE DAY BEFORE. <br />j <br />696331 <br />I <br />