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❑ Feller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island rX Forward Sanitary Landfill Landfill Sanitary Landfill Sanithry Landfill Landfill 901 Bailey Road 28972 Cofflh Butte 116ad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road Pittsburg,CA 94565 r'6.� Con+:'allis, OR 97330 Half Moon Bay,CA'94019 Milpitas,CA 95035 Manteca, CA 95336 Phone(925)458-9800 Phone(541)745-2018 . Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 Fax(925)458.-9891 Fax(541)745-3626 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 l NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. Hit atxrRel*�xuxl MAILING ADDRESS 61 0 111161-M 9 an ve CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT MXKkt�CA 95203 6 GLOVES ❑GOGGLES' 0 RESPIRATOR' ]HARD HAT PHONE (209)469-0625 - ❑TY VEK ❑ SAFETY VEST CONTACT PERSON get C SPECIAL HANDLING PROCEDURES:. . . SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE GENERATOR'S CERTIFICATION;I hereby certify that the above named rnaterial Is not a hazardous waste as defined by 40 CFR Part 261 or title 22 of the California code 61 regulations,has been property described,classified and packaged,and is In proper:condition for transportation&*cording to applicable regulallons;ANq If the waste is a treatment residue of a previously restricted hazardous waste . au jest la the Land Disposal Restrictions,I certify and warrant that the waste has been treated In RECEIVING FACILITY 'accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by 40 CFR Pert 261. —� WASTE TYPE: E. DISPOSAL O SLUDGE ❑CONSTRUCTION U WOOD _ ❑DEBRIS ❑OTHER U SPECIAL WASTE GENERATING FACILITY 2025 W.Haeltou Ave BTCCKTO14 _ TRANSPORTER NOTES: VEHICLE LICENSE NUMBER . TRUCKNUMBER ADDRESS J" �SCSI 7G 2710 L.Oanis load CITY,STATE,ZIP 3tocetai6CA 95205 PHONE END DUMP BOTTOM DUMP TRANSFER Z '456-1145 SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS CUBIC YARDS . hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: ` (TO BI~COMPLEYED BY:LANDFILL) Is true and accurate. DISPOSE ``.OTHER REMARKS a SOIL ❑CONSTRUCTION FACILITY TICKET NUMBER DEBRIS ❑NON-FRIAi3LE .,. ASBESTOS SIGNATURE OF AUTHORIZED AGENT DATE L)WOOD ! f ❑ASH O SPECIAL OTHER SCHEDULING MUST BE MADE PRIORTO 3:00 IP.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON .ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE,DAY BEFORE. OCNERATOR COPY MANIFEST 77 .