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El.Keller Canyon 0 Coffin Butte D Ox.Mountairi ❑Newby island <br /> rX Forward <br /> 'T Sanitary landfill Landfill Sanitary Landfill Sanitary LandfiN 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 gorvaitisv,OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035s <br /> Manteca, CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)72641819 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)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> H as srR� . WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ve ._ .0939 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> MOMMCA 1(�3 �r <br /> PHONE cif GLOVES ❑GOGGLES, a RESPIRATOR NU HARD HAT <br /> 469-0625 <br /> Q TY VEK ❑ SAFETY VEST .: <br /> CONTACT PERSON <br /> ]3st E'er 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 tills 22 of the California code of regulations,hes been properly ; <br /> �f. described,classified and packaged,and Is in proper condition 10(transportation s-cording 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 <br /> aacordanoe with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> ^- 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL-,.' ❑SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> Q DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.H;»Iton Ave St�t'Le.'TOItI <br /> TRANSPORTER <br /> NOTES:. VEHICLE LICENSE NUMBER .TRUCK NUMBER: <br /> ADDRESSL 07 71 2. <br /> . <br /> CITY,STATE,ZIP '. <br /> PHONE E=ND DUMP BOTTOM DUMP. TRANSFER - <br /> (29Z 456-11145U. <br /> GN UN OF AUTHORIZED AG • T OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ L1 a i <br /> CUBIC YARDS <br /> hereby certify that the above named materlaihas,been <br /> accepted and to the best of my krwiedge the foregoing DISPOSAL MET-HOD: (TO 8E COMPLETED,BY LANDFILL) <br /> is true and accurate,' , <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUM E DEBRIS <br /> O:NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTViORIZqD AGENT DATE <br /> Q WOOD <br /> ❑ASH. <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE ADE PRIORTO 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDOLED WITH THE LANDFILL.THE DAY BEFORE:. <br /> GENEMATOA C.Ot Y <br /> MANIFEST.# " <br /> ; 649'6 <br />