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L.!Keller Canyon LICoffilq Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> S,ardtbity 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 Ijay,CA40 <br /> 919 Milpitas, CA 95035 Manteca,CA 85336 <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)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> Yet <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> St <br /> A 95203 N GLOVES Q GOGGLES U RESPIRATOR YUHARD HAT <br /> PHONE <br /> (209f 4k2&M U TY VEK U SAFETY VEST <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> DrdtContif dli <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR`$CERTIFICATION:I hereby cortify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 281 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 sording to applicable <br /> regulations;AND,II 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 288 and is no longer a hazardous waste as donned by <br /> 49 CFR Part 281. <br /> WASTE TYPE: <br /> X DISPOSAL U SLUDGE <br /> C]CONSTRUCTION U WOOD <br /> 13 DEBRIS C]OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2,02,5 W.Hezdtun Ave STOCKL't�N <br /> TRANSPORTER NOTES; I VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Ij Mr.Tru&t r <br /> ADDRESS <br /> 2710 L 2M!s Rind <br /> CITY,STATE,ZIP <br /> '8tQCkt011,CA;52O5 <br /> PHONE END DUMP BOTTOM DUMP.., . TRANSFER <br /> 45&1145 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> �k 1 <br /> j CUBIC YARDS <br /> j <br /> hereby certify that the above named material has been <br /> accepted and to the best Of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE -OTHER <br /> U SOIL <br /> EMARKS <br /> C]CONSTRUCTION <br /> FACILITYTICKEII,NWMBER -DEBRIS <br /> C]NON-FRIABLE " <br /> ASBESTOS <br /> SIGNATURk OF 4lUTHORIZED AGENT DATE <br /> U WOOF] <br /> "XflU ASH <br /> U.SPECIAL OTHER <br /> SCHEDUL G MU#BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> T70 REFU ALPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAYBEFORE. <br /> OFNERATOP COPY. MANIFEST# J6490.9 <br /> s - <br />