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❑"Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island Lel Forward <br /> Sanitary Landfill Landfill Sanitary Landfill b. Sanitary Landfill Landfill <br /> 901,Bailey.Road 2897?,Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis,0R17330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca CA 95 <br /> Y p � 336 <br /> Phone(925)458-9$00 Phone(541)745-2018. Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax{925)458 9691 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 /> Heatrtlk,a Rtc+lu�oes <br /> MAILING ADDRESS <br /> vta — <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> N GLOVES ❑GOGGLES ❑RESPIRATOR Y]HARD HAT <br /> 26 -062G.TY VEK © SAFETY VEST <br /> CONTACT PERSON <br /> Brett G SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENEAA70R'8 CERTIFICATION:I hereby cer ity that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous was W <br /> subject 10 the Land Disposal Restrictions,I certify and warrant that the waste hes 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 /> DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION Ll WOOD <br /> ©DEBRIS ❑OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> X025 W,H&Ddt1X1 Ave STWI .'Tt]N <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSrJ� �I 76 <br /> F710 L.oatniS Road <br /> CITY,STATE,ZIP <br /> PHONE END DUMP. BOTTOM.DUMP "TRANSFER <br /> f)3156.1145 U, . . LI " <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED ,VAN "DRUMS <br /> ❑ ❑ [� [ <br /> r * --dor q ISOk l� t ll <br /> CUBIC YARDS <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. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> ` d CONSTRUCTION <br /> FACILITY TICKET NUMBER . DEBRIS <br /> 4 NON-.FRIABLE - <br /> ASBESTOS <br /> SIGNATURE OFAUTHOR IZ NT DATE <br /> O WOOD <br /> t <br /> F-11 ASH' <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE Mj<96 PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS"ARE SUBJECT <br /> TO REFUSAL UPON ARITIVAL. ONGOING DAILY DELIVERIES MUST:BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE: <br /> MANIFEST <br /> GENERATOR COPY 1. # +��_�"� 1. <br />