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Ll Keller"Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island ® Forward <br /> Sanitary Landfill Landfill Sanitary Landfill �Sanitary. Landfill Landfill. <br /> 901 bailey Road 28972 Coffin..Butte Road 12310 San Mateo Road 1601 Dizon Landing Road 9999 S.Austin Road <br /> 1 Pittsburg,CA 94565. Corvallis,-QR 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)9824298 <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 /> Hit ager R� <br /> MAILING ADDRESS <br /> VC' <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ' 6GLOVES ❑GOGGLES ❑RESPIRATOR HARD HAT <br /> PHONE <br /> 209 469 0625 O TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> 1. om <br /> SIGNATURE OPAUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S'CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> �waste as deflnd by 40 CFR Part 261 or title 22 of the Calitomia 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,It 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 in RECEIVING FACILITY <br /> accordance with the repuirements of 40 CFR Part 268 avid is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL 4 SLUDGE <br /> O CONSTRUCTION 0 WOOD <br /> ❑DE&IS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 21745 W.Hamthm Ave 3T0CR"Tt7H _... <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Trulker . <br /> ADDRESS <br /> 7]0Lo nisRaaf <br /> CITY,STATE,ZIP <br /> M. <br /> PHONE. END DUMP. BOTTOM DUMP TRANSFER <br /> (ZOr 456.1145 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> `0 <br /> CUBIC YARDS <br /> hereby certify that the above named material has.been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPI TED BY 1 ANDFiLL) <br /> Is true and accurate. <br /> k DISPOSE '' OTHER <br /> O SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> -U WOOD <br /> 1 U ASH <br /> Ll SPECIAL OTHER. <br /> SCHEDULING MUST BE MADE PRIORTO3:00 RM.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCkE'DULED WITH THE LANDFILL THE DAY BEFORE. <br /> GEN!cR"TC�COPY MANIFEST# <br /> �: '6 <br /> 454 <br />