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Relief Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island IN Forward <br /> AsnitarI Landfill Landfill Sanitary Landfill Sanitary 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)726-9183 Fax(408)262-2871 7 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hea akbcr R m <br /> MAILING ADDRESS <br /> Aveit=W,.Ha1DWUn -- <br /> 6939 <br /> CITY STATE,' IP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> '�� 6GLOVES O GOGGLES U RESPIRATOR� U HARD.HAT <br /> Z 4G9-0G� U TY-VEK U SAFETY HEST <br /> CONTACT PERSON <br /> rdt. »rrt SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE . DATE <br /> * I <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material isnot a hazardous <br /> waste as defined by 40 CFR Part 261 or this 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and Is In proper condition for transportation a^oording to applicable <br /> regulations;AND,If the waste is a treatment residua of a Pr""aty restricted hazardous waste <br /> sublet,to the Land Disposal Reatdctione,I certify and warrent that the waste has been treated M 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 Pen 261. <br /> WASTE TYPE; <br /> DISPOSAL_ U SLUDGE <br /> U CONSTRUCTION O WOOD . <br /> U DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 WL H,awltoti Ave �tsl Tt N <br /> TRANSPORTER NOTES: VEHICLE LICENSE <br /> -tt <br /> LICENNSE NUMBER T�RUCK NUMBER <br /> ADDRESS <br /> 2710 Loomis s R 3 <br /> CITY,STATE,ZIP <br /> PHONE - END DUMP BOTTOM DUMP TRANSFER <br /> (209)45&114-5 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT=BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named materlaI 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 /> REMARKS U SOIL <br /> U.CONSTRUCTION <br /> DEBRIS <br /> FACILITY. .ICKET NUMBER UNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE10FMTHORIZEDAGENT DATE <br /> O WOOD . <br /> ASH <br /> * U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PIORTO 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 /> GENERATOR COPY MANIFEST# 564956 <br />