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CD Keller Canypn; El Coffin Butte El-ox Mountain ❑Newby Island ® Forward $antt ray Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill I 901 Bailey"Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road Pittsburg, CA 94565 Corvallis,OR 97330 Half Moon Bay�CA 94019 Milpitas, CA 95035 Manteca,CA 95336 Phone(925)458-9800 Phone(541)745-2018Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 Fax(925)458-9891 Fax(541)745-3816, e Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-100 9 NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. Headwttt�r R�xtnraex+ MAILING ADDRESS ve -- . CITY,.STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT mowa-4c'A PHONE GLOVES ❑GOGGLES ❑RESPIRATOR Aa HARD HAT 469'0525 ❑TY-VEK ❑ SAFETY VEST CONTACT PERSON SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT/TITLE DATE • I GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous waste as defined by 46 CFR Part 261 or title 22 of the California code of regulations,has been properly dascrlbed,classified and packaged,and is In proper condition for transportation 9-cording to applicable regulations;AND,It the waste is a treatment residue of a pravtousfy restricted hazardous waste subject to 1he tend Disposal Restrictions,I certify and warrant that the waste has'been treated in RECEIVING FACILITY accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined b1 40 CFR Part 261. WASTE TYPE: X DISPOSAL O SLUDGE ❑CONSTRUCTION O WOOD ❑DEBRIS 0 OTHER ❑SPECIAL WASTE GENERATING FACILITY I025 W Ht' Iton,t4,ve OC 'Tt N TRANSPORTER NOTES:. VEHICLE"LICENSE NUMBER . TRUCK NUMBER 1VIr.Trucker ADDRESS. 2710 I mi-da Road CITY,STATE,ZIP Stoi act,C t Q5M5 PHONE 1145 END DUMP BOTTOM DUMP TRA S ER X09 456. [� SIGNATURE OEA.UTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT BED VAN DRUMS CUBIC YARDS . t hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing pISP05AL METHOD: " (TO BE C(�MPLETBY LANDFILL) Is true and accurate: @ DISPOSE OTHER REMARKS ❑SOlL,.t ❑CONSTRUCTION FACILITY TICKET NUMBER— DEBRIS F ❑ NON-FRIABLE ASBESTOS. SIGNATURE OF AUITHORIZED AGN DATE ! O WOOD O ASH " U,SPECIAL OTHER immomd SCHEDULING MUST BEKAbE PRIORTO 3:00 P 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: G€NERAAS06PY MANIFEST# . 49 /�f 9' ) i t"