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❑ Keller Canyon Q Coffin Butte ❑Ox Mountain ❑ Newby Island" LN Forward <br /> Sanitary Landfill Landfill Sanitary Landfill' Sanitary Landfill Landfill <br /> 901 Bliley Road ¢28972Coffiyi Butte RQad 12310 San Mateo Road 1601 Dixon Landing Road 9999;5,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 Fax(209)982-1"009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. .. <br /> Z I $w a# i Rc >s <br /> MAILING ADDRESS 6939 . <br /> Ave <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t'M, A S9SZU3 5GLOVES ❑GOGGLES ❑RESPIRATOR ►]HARD HAT <br /> PHONE <br /> 469.0625. U TY VEK. 0 SAFETY VEST <br /> CONTACT PERSON <br /> Brdt <br /> C anI>I SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Caltlomla code of regulations,has been property <br /> described,classified and packaged,and is In proper condition for transportation a cording to applicable <br /> rogulation9;ANTI,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I comity,and warrant that the waste has been treated in RECEIVING FACILITY <br /> aorordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as dellned by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> ❑DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W,Hamitan Acre STf 'T-ISN <br /> T��RrrANNSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSC <br /> 2710 Loxxiiis Roan <br /> CITY,STATE,ZIP ' <br /> PHONE END DUMP BOTTOM DUMP � TR ER <br /> (2M 4501145 <br /> ❑. ❑ . <br /> SIGNATLME.OF AUTHO IZED AGENT OR DRIVER DATE ROLL-OFF(S) -FLAT-BED VAN DRUMS <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 /> REMARKS v„SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> I ASBESTOS <br /> SIGNATURE OF AUTHORI D AG NT DATE <br /> ❑WOOD <br /> ASHA. <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MAD & RIORTO 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 TWE.DAY BEFORE. <br /> GENE14ATOR COPY . MANIFEST# 5AA <br /> 64962. <br />