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L-_!Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island ® Forward <br /> -Sanitary Landfill . Landfili 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 /> 1. Pittsburg,CA 94565 Corvallis,OR 97330 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> i Phone(925)458-9800 , Phone(541)745-2018. Phone(650)726-1819 Phone(406)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891Fax(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 /> .MAILING ADDRESS <br /> RiMtm Ave — . <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ll'CA 95203 GLOVES U GOGGLES U"RESPIRATOR YUHARD HAT <br /> PHONE <br /> Zl <br /> 469-0625 U TY--VEK U SAFETY VEST <br /> CONTACT PERSON <br /> P GcalVM 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 cr title 22 of the California code of.regulations,has been properly <br /> described,classified and packaged,and is In proper condition for transportation aiaoid'ing to applicable <br /> regulations;AND,If 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 requirements of 4.0 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL 4 SLUDGE <br /> ❑CONSTRUCTION Q WOOD ' <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 025 W.H eltat Ave UP)CKTON <br /> TRANSPORTER NOTES: I VEHICLE-LICENSE NUMBER . TRUCK NUMBER <br /> I+1I! Trucker JJ,, <br /> ADDRESS U <br /> �7�t1 �ti�lfia�d <br /> CITY,STATE,ZIP <br /> 3tt tM'%.:A 95M <br /> PHONE . END.DUMP -BOTTOM DUMP. TRANSFER <br /> Z 45+-1145 ❑... <br /> SIG URE OF AUTHORIZE AGENT OR DRIVER DATE . ROLL-OFF 5" f FLAT=BED-- VAN DRUMS <br /> CUBIC YARDS <br /> I 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 c0 LD BY LANDFILL) <br /> Is true and accurate: <br /> r;, <br /> DISPOSE OTHER, <br /> c SOIL .: <br /> iREMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMB DEBRIS <br /> U NON-FRIABLE = <br /> ASBESTOS ` <br /> SIGNATURE OF AUfrHORIZED AGENT DATE <br /> ❑WOOD <br /> / U ASH <br /> i <br /> j U SPECIAL OTHER <br /> l <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-"ANY UNSCHEDULED LOAdt-ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES:MUST BE SCHEDULED WITH THE LANDFILL THE DAY'BEFORE: , <br /> ENEfitTOR COPY ;`� MANIFES <br /> C� <br /> r C <br />