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0 Keller Canyon.. , ©Coffin Butte ❑Ox Mountain 0 Newby Island X Forward <br /> it <br /> .Sanitafy 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 /> Phone(925)458-9800 Phone(541)745-2018_ Phone(650)726-1819 Phone(408)945-2800 Phone(249)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-287.1 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Heti at�rr Ria - . <br /> MAILING ADDRESS <br /> ve — <br /> 6939 , <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Mcdden+CA 95203 <br /> . NGLOVES O GOGGLES "O RESPIRATOR X]HARD HAT <br /> 209 0625 ❑TY VEK : Q SAFETY VEST <br /> CONTACT PERSON <br /> Brtft CoWeen. 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 261 or title 22 of the Celitomia 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 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 Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION 17 WOOD <br /> ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.Hamilton Ave S'. O KT014 <br /> TRANSPORTER NOTES: IVEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I& Trucker �1 <br /> ADDRESS `7' 01 <br /> 2710 LOMAR Road <br /> CITY,STATE,ZIP <br /> :31tock tan,0'.A 95285 <br /> PHONE END DUMP BOTTOM DUMP " TRANSFER <br /> 209 450.1145 <br /> SIGNATIJRE-QAUTHORIZEDLAGENT OR DRIVER, DATE ROLL-OFFS FLAT-BED'. VAN DRUMS <br /> CUBIC YARDS <br /> 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. olsposAL METHOD: (To BE CaMPLTEo°sY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑SOIL <br /> u CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTH RIZED AGENT DATE <br /> { Q WOOD. <br /> :G a-ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT _ <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE�D+AY BEFORE <br /> OENERATOPI COPY MANIFEST# C?4 9 5�': <br />