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.❑ Keller Canyon i, ❑Coffin Butte ❑Ox Mountain ❑ Newby Island L Forward <br /> Sanitary Lafidfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 961 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)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 /> Hc�tstwsl+�Rettnae�+ . <br /> MAILING ADDRESS _ <br /> Ave <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sto*11m,C-A 95203 5 GLOVES ❑GOGGLES ❑RESPIRATOR A❑HARD HAT <br /> PHONE <br /> X09 449--0625 a TY--VEK a SAFETY VEST <br /> CONTACT PERSON. SPECIAL HANDLING PROCEDURES: <br /> Breit Cckflpm <br /> SIGNATURE OF AUTHORIZED AGENT 1TITLE 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 California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-.00rding to applicable. <br /> regulations;AND;if the waste is a treatment residue o1 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 26B and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS, ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2OZ5 VV:ffmeiton Ave �"Tt irf <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER . <br /> ADDRESS <br /> 2710 Lmnis Rom <br /> CITY,STATE,ZIP <br /> Stockl;MCA 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 456.1145 ❑ :❑ <br /> SIG TUBE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS . <br /> * ~1,207 <br /> CUBIC YARDS <br /> 1 hereby certify.that the above.named material has been <br /> _ it . <br /> accepted and,to`the best of my knowledje the foregoing DISPOSAL METHOD: (TO BE Cb pD BY LANDFILL) <br /> is true orris! accurater <br /> DISPOSE OTHER <br /> so <br /> IL <br /> EMARKS. <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ' ❑NON-FRIABLE <br /> r :ASBESTOS <br /> SIGNATURE OF AUTHO IZED AGENT-. :f = DATE <br /> ❑wooD <br /> ❑ASH <br /> J91 �. <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 DAY BEFORE <br /> GENll_RATOM COPY MANIFEST 0. L.6 <br />