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❑ Keller Canyon <br />Sanitary Landfill <br />901 Bailey Road - <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />El Coffin Buttl,—, <br />❑.Ox Mountain <br />El New' Island <br />Landfill <br />Sanitary Landfill <br />Sanit* Landfill <br />28972 Collin Butte Road <br />12310 San Mateo Road <br />1601 Dixon Landing Road <br />Corvallis, OR 97330 <br />INIf Moontay, CA 94019 <br />Milpitas, CA 85035 <br />Phone (541) 745-2018 <br />Phone (650) 726-1.819 <br />.Phone (408) 945-2600 <br />Fax (541) 745-3826 <br />Fax (650) 726-9183. <br />Fax (408) 262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />WASTE TYPE: <br />ard <br />Landfill ( <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERATOR <br />WASTE ACCEPTANCE NO. <br />Ax <br />e C14 v <br />MAILING <br />ADDRESU� <br />CITY, STATE, ZIP <br />J_ <br />PHONE . <br />J4 <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />40LOVES ❑ GOGGLES ❑ RESPIRATOR IABD HAT <br />❑ TY-VEK WFETY VEST <br />C - NTACT PERSON <br />- <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT /TITLE <br />DAT <br />ae ,, <br />GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous <br />waste as defined! by 40 CFR Pad 261 or tl8e 22 of the Callfomia code of regulations, had been properly <br />`.described, classified and packaged, and is In proper condition for banspodalion according to applicable <br />regulations, AND, If the waste is a treatment residue of a previously restricted hazardous waste <br />subject to the Lard Disposal Restrictions, I certify and warrant that the waste has been treated In <br />accordance whh the requirements of 40 CFR Pad 288 and is no longer a hazardous waste as defined! by <br />40 CPR Part 287. - <br />RECEIVING FACILITY - <br />- <br />WASTE TYPE: <br />❑ DISPOSAL - ❑ SLUDGE <br />❑ CONSTRUCTION ❑ WOOD <br />❑ DEBRIS - ❑ OTHER <br />❑ SPECIAL WASTE <br />. <br />- <br />- <br />GENERATING FACILITY <br />TR SPORTERNOTES: <br />- <br />VEHICLE ucFNsE NUMBER TRUCK N MBER <br />.D d iW �; <br />� ,�.. <br />ADDRESS <br />/ <br />CITY, STATE, <br />PHON <br />END DUMP BOTTOM DUMP TRANSFER <br />❑ ❑ ❑ <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER <br />DAT <br />ROLL -OFFS FLAT-BED VAN DRUMS <br />❑ ❑ ❑: <br />I hereby -certify that the above named material has been <br />accepted and to the best of my knowledge the foregoing <br />Is true and accurate. <br />- <br />CUBIC YARDS <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑-SOIL <br />REMARKS <br />❑ CONSTRUCTION <br />N <br />- <br />FACILI TICKET NUMBER <br />❑ NOON -FN -F RIABLE <br />A ESTO <br />8fGNATIJRE QF AUTHORIMD AG <br />D <br />T <br />W D; <br />r <br />i <br />` <br />❑ <br />AS J <br />SP IAL O HER <br />SCHEDULING MUST BE MADE PRIOR -00 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL • ANY uaserYmuuLt:U s-vAva Ane avow FC. r <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />.-tum NR-n9A - GENERATOR COPY MANIFEST 9 1 .n.ol- f n 7 <br />