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:IJ Keller Canygn ❑Coffin Butte0 Oz Mountain El Newby Island LM Forward <br /> Sanitary Landfill Landfill Sanitary Landfill 3 Sanitary Landfill Landfill <br /> is 901 43ai)ey Road 28972 Coffin Butte Rgad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 e` Corvallis, OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> !' Phone(925)458-986 "'Phone(541)745-2018: Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Y 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 WASTE ACCEPTANCE NO. <br /> Hca 8UrRc9aLtt = <br /> MAILING ADDRESS6939 etr — <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE GLOVES. ❑GOGGLES .0 RESPIRATOR HARD HAT <br /> -WO ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLINGPROCEDUAES. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:-1 hereby certify that the above named material Is not hazardous <br /> waste as defined by 40 CFR Part 261 or fitle 22 of the Catifomia code of regulations,,has been properly <br /> described,classified and packaged;and Is In proper condition for transportation axording to applicable r, <br /> regulations:AN if the waste is a treatment residue o1 a <br /> reg Q 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 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. ., <br /> WASTE TYPE: <br /> X DISPOSAL a SLUDGE <br /> O CONSTRUCTION I]WOOD <br /> O DEBRIS d OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> =5 Tdlf.IWOton Ave <br /> TRANSPORTERMM <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER . <br /> Mr.Trucker <br /> ADDRESS <br /> � <br /> V30 LclMWa RKMd <br /> CITY,STATE,ZIP <br /> St a%ch 95M <br /> PHONE END DUMP BOTTOM DUMP TRANSFER , <br /> 2 45&114 <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 material.has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMi�CETED,BY tANDFILh) <br /> Is true and.accurate. <br /> ....• , . . . DISROBE . .OTHER. , I <br /> REMARKS O 501E <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS . <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHOR <br /> AGENT DATE ASBESTOS <br /> ❑WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST&4ADE PRIORTO 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 THE DAYBE�+BEFORE.' ' <br /> QENERATOR COPY, MANIFEST# ,64967 <br /> 4 Qv►U 7 <br />