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El Keller Canyon . El Coffin Butte ❑Ox Mountain 0 Newby Island IN Forward <br /> . . Sanita6 Landfill Landfill Sanitary.Landfill Sanitary Landfill 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 Corvallis, OR 97330 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> i f -9800 ` Ph6ne(541)745-2018 Phone(650)726-1819Phone(925)458 Phone(408)945-2800 Phone(209)982-4298 <br /> ` Fax(925)458-9891 Fax(541)745-3826 Fax 650 725-9183 Fax 408 262-2871 Fax 2 - <br /> . . � ) ( } ( 09)982 1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Herr Recrt <br /> MAILING ADDRESS <br /> ME VT mAve — . <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 2 GLOVES , 0 GOGGLES ❑RESPIRATOR "U HARD HAT <br /> Z 469-0625 , 0 TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> BM_t CCM Fm 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 281 or tide 22 of the Califomla code of regulations,has been properly <br /> k described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> f regulations;AND,If the waste Is s luestment residue of a previously restricted ha=erdous 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 Par!268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2f)25 W,Hizeitae?<Ave STO+C'KtTOId <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I r. to <br /> ., ADDRESS 73 <br /> 2710 Loomis Rced <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM UMP. TRANSFER <br /> (-25-9-)45&n45 � r <br /> SIGNATURE OF AUTHORIZED AGE DRIVER DATE. ROLL-OFFS FLAT-BED , VAN DRUMS <br /> ❑ ❑ ❑ ❑. <br /> 1 <br /> CUBIC YARDS <br /> hereby certify that the above named materiei has been <br /> accepted and to the beat of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD: (TO BEC Y NDFILL) <br /> DISPOSE . OTHER <br /> ❑SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 1. G]NON-FRIABLE <br /> ASBESTOS <br /> SIGN- UR OF AUTHOR ED AGENT DATE <br /> U WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING V6ST BE ADE.PRIOR TO 3:00 P M.7HE DAY:PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSA UPON RRIVAL. ONGOING DAILY DELIVERIES MUST It SCHEDULED WITH THE LANDFILL THE;DAYBECCFORE.' <br /> GENERATOR `45' <br /> COPY. MANIFEST#., �� .�]�J,Q <br />