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❑ Keller Canyon ❑Coffin But ❑Ox Mountain ❑ Ne Island ❑ Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sarlpy Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon 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)726-911]3 Fax(408)262-2871 � 09 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> EN ATOR WASTE ACCEPTANCE NO. <br /> t c"- <br /> G DRESS <br /> 1 STATE, Zip REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> P O E <br /> � �- " ❑GLOVES ❑GOGGLES ❑.RESPIRATOR ❑HARD HAT <br /> Q TY-VEK Q SAFETY VEST <br /> ON ACT PE ON <br /> SPECIAL HANDLING PROCEDURES <br /> t <br /> SIWATUREOFAUT ORIZEDAGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATIONASereby certify that the abwe 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 property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a prselously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I cer4ty and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> Q DISPOSAL Q SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> O DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ ❑ <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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE FAUTHO IZEDAGENT DATE <br /> f Q WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST k <br /> TRANSPORTER COPY .L <br />