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Q Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby "� and�` , " C 0&4v rd T <br /> Sanitari"Landfill Landfill Sanitary Landfill "Sanitary'Lal-ndfill ''" r Landfill <br /> 901 Bailey Road 28972 Coffin-Butte Rodd 12310 Sal!Mateo Road 1601 Db(o.1 Landing hsQ d f° 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 MantPhoneca, <br /> a, C 0633698 <br /> Fax(925)458-9891 Fax(541)745-3826 <br /> Fax(650)726 9183 Fax(408)262-2871 Fax(209)982-1009, <br /> xNON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hen.'fttjes Rcaacxr <br /> MAILING ADDRESS <br /> Ave w <br /> 6939 <br /> CITY,STATE;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> HONE A C!GLOVES ❑GOGGLES 0 RESPIRATOR NU HARD HAT <br /> PHONE <br /> O9 ' -X32I ❑TY.VEK U SAFETY VEST <br /> CONTACT PERSON <br /> Brett.CC09M 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 California code of regulations,has been properly <br /> described,classified and packaged,and Is In proper condition for transportation aroording to applicable <br /> regulations;AND,N the we is a treatment residue of a Previousty restricted hazardous weals <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste hes been treated in RECEIVING FACILITY <br /> accordance With the'requlrements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281:, <br /> WASTE TYPE:': ' <br /> pISPOSAL U SLUDGE <br /> 0 CONSTRUCTION O WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.Hazeitata Ave STWXT01f <br /> e <br /> TRANSPORTER Tlucker NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER ' j ADDRESS r` 7 3 <br /> 7710 Lolxi*Rdad : <br /> CITY,STATE,ZIP 1 I <br /> t <br /> PHONE <br /> (209)TSG-11A� END DUMP BOITOM DUMP TRANSFER, <br /> � ❑ - <br /> 51GNAT E OF AUTHORIZED AGENT OR DRIVER _ DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> Q Q ❑ L <br /> Jr <br /> CUBIC YARDS f <br /> 1 hereby certify that the above named material has been <br /> accepted and to the.best of my knowledge the foregoing <br /> Is true and accurate. DlswosAL METHOD: (TO BE COMLErEo BY I:AIVDFILL) <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> 'ASBESTOS <br /> 51GNATURE OF AUTHO ZEDAGENY DATE <br /> Q WOOD <br /> ASH <br /> ❑SPECIAL.OTHER k <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIQRTO EXPECTED ARRIVAL`-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST'BE.SCHEDULED'WITH THE"LANDFILL THE.DAfY BE970 <br /> �F(OAEi' I <br /> f3ENERATOR•COPY MANIFEST# "t i 47 <br /> / .i <br />