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0 Keller'Canyon., ❑Coffin Butte 17 Ox Mountain ❑ Newby Island IN Forward "Sanitary-,LandT!il Landfill Sanitary'Lendfill ;.1,Sanitery Landp Landfill 901 Bailey Road 28972 Coffin-Butte Road 12310 San Mateo Road i°160"hDlxon LandingFload 9999 S.Austin Road Pittsburg,CA 94565 Corvallis,OR 97330 Half Moon Bay,CA.94019 Milpitas, CA 95035 Manteca,CA 95336. Phone(925)458-9800 Phone(541)745-2018 Phone(650)7 26-1819 Phone(408)$45-2800 Phone(209)982-4298 Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 .. N9.N=HAZARDOUS WASTE MANIFEST G6939 , ENERATOR WASTE ACCEPTANCE NO. Headwater Rmmz= MAILING ADDRESS W,HiZALM Ave "" CITY STATE,ZIP REQUIRED PERSONAL PR TECTI E EQUIPMENT St �'��'A37 GLOVES ❑GOGGLES ❑RESPIRATOR Y3 HARD HAT PHONE 2 469.0675 ❑FY VEK ❑ SAFETY VEST . CONTACT PERSON Breit Cculiitoat SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT/TITLE DATE GENERATOR'S"CERTIFICATION:I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFR Part 281 or tide 22 of the Caffomla code of regulations,has been properly described,classified and packaged,and Is In proper condition for transportation a�eoniing to applicable regulations;AND,N the waste Is a treatment residue of a Previously restricted hazardous waste subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY accordance with the requirements of 40 CFR Part 288 and Is no longer s hazardous waste as defined by 40 CFR Part 261. WASTE TYPE: . X DISPOSAL 0 SLUDGE ❑CONSTRUCTION D WOOD O DEBRIS a OTHER ❑SPECIAL WASTE GENERATING FACILITY 2()25 W.Hazeltan Ave STt CP."I OH TRANSPORTER NOTES: VEHICLE LICENSE.NUMBER TRUCK NUMBER, ADDRESS �P�^ (0 �.� 7< CITY,STATE,ZIP Sk. On CA.95205 PHONE END DUMP ' BOTTOM DUMP" TRANS ER (209)456-1145 SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLLOFF S FLAT-BED- VAN DRUMS ❑ " CI ❑ d i CUBIC YARDS I hereby certify that the above named material has been i accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) Is true and accurate. DISPOSE OTHER. O SOIL EMARKS U CONSTRUCTION k FACILITY I KET NUMBER DEt3RIS 0 NON-FRIABLE " ASBESTOS +° SIGNATUPE F AUTHORIZED AGENT DATE ❑WOOD. U ASH O SPECIAL OTHER SCHEDULE ST BE MADE PRIOR.M 3:00 P.M.THE DA PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST.BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE GENERATOR COPY MAN,1FEST# 5-64955, # .