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Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island f.4 Forward <br /> SanitAry Undf ill 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 /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> ;Fax(925)458-9891 Fax(541),1745-3626 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO... <br /> at� e 1 <br /> MAILING ADD ESS _ <br /> nIVIZO MU 1MV V. <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> St*dd°n't"A 95204 .GLOVES O GOGGLES. 4 RESPIRATOR. Yt)HARD HAT <br /> PHONE <br /> (209)469-0625 ❑TY-VEK U SAFETY VEST . <br /> CONTACT PERSON 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 Wardous <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 a`cording to applicable <br /> regulations;ANA It the waste Is a treatment residue of a pre6lousty restricted hazardous waste <br /> subject to the land disposal Restriotlons,i certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Pert 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 ❑WOOD ' <br /> ❑DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 5 W,Ha=ltcn Ave S'T'o ckr< N <br /> 7. <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBED ' TRUCK NUMBER <br /> ADDRESS <br /> ��7/ , . ,)5 <br />` <br /> 2710 Lmnis <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP.. TRANSFER <br /> ( }4.5$-1145 ❑: . <br /> Si URE OF AUTHORIZED AGWT OR DRIVER DATE ROLL-OFFS FLAP-BED VAN DRUMS <br /> CUBIC YARDS I R <br /> I hereby certify that the above named.material has been <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br />'I DISPOSE OTHER . <br /> D SOIL <br /> REMARKS <br /> O CONSTRUCTION - <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE TFAUTHOPIZED.AgENT DATE <br /> O.WOOD <br /> ©'ASH. m : <br /> l ©SPECIAL OTHER <br /> 'EDUCING MUST BE dAdE PRIORTO 3:00 P.M.THE DAY PIRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 'EFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULEO WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOI�,COPY MANIFEST#. : .. <br /> i. <br />