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i <br /> O Keller Canyon O''Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> Sanitar� Landfill Landfill Sanitary Landfill <br /> 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 35336 <br /> '! Phone(925)458-9800 Phone(541)745-2018 Phone(550)726-1819 Phone(408)945-2800 Phone(209),982-4298 <br /> I_ Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON104,ARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Hey der kcsrna WASTE ACCEPTANCE NO. . <br /> MAILING ADDRESS <br /> irn Ave — <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> jM, . <br /> PHONEGLOVES O GOGGLES °D RESPIRATOR XUHARD HAT <br /> 2 469-0625 D TI-VEK., Q SAFETY VEST <br /> CONTACT PERSON <br /> Wmt # SPECIAL.HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 7k. <br /> GEN&ATOR'S CERTIFICATION:I hereby certify that the above named malarial Is not a hazardous <br /> waste as defined by 40 CFR Pad 261 or tide 22 of the California 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,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> aubjeal to dre land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> actordanoa with the requirements of 40 CFR Part 26B and is.no longer a hazardous waste as defined aY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL D SLUDGE <br /> D CONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER <br /> D SPECIAL WASTE <br /> GENERATING.FACILITY <br /> X025 W.Hazelton Ave STO CKTON <br /> t " <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBERT RUCK NUMBER <br /> ADDRESS ! • <br /> 7710 LTXmta Rlaa <br /> CITY,STATE,ZIP <br /> Stumon,C& <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> QM 456.1145 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AG NT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> Q Ll <br /> CUBIC YARDS. <br /> I 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. DISPOSAL METHOD: (TO 8E COMPLEi ED.BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS O SOIL <br /> ❑.CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS . <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHOF3 IZED AGENT DATE ASBESTOS <br /> D WOOD <br /> r i:• O ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS AAE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES'MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE.' <br /> GENEfRATOR;COPY . MANIFEST# 4 J " <br />