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W Keller Canyon L,Coffin,Butte ❑Ox Mountain ❑ Newby Island ® Forward <br /> Sanitary°Landfill Landfill Sanitary 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 <br /> Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800Phone(209)982-4298 <br /> Fax(925)456-9891 Fax(541)745-3826 Fax(650)726.9183 Fax(408)262-2871 Fax(209)982-1009 <br /> r NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Hraltier Revmrom WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 1559 VM__AV 0 69,39 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> MxdCtCn,C,A 9520.3 PHONE _5GLOVES 0 GOGGLES ❑RESPIRATOR %HARD HAT <br /> 4459-06 0 TY-VEK 0 SAFETY VEST <br /> CONTACT PERSON <br /> Brett.C.mlem 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 California code of regulations,has been property. <br /> desoribed,classified and packaged,and is In proper condition for transportation a^cording to applicable <br /> regulations;ANO,If 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 CFA Pad 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2W W,H Iten Avi: STO#."KTON <br /> TRANSPORTER NOTES:' VEHICLE LICENSE NUMBER. / TRUCK NUM�BIER <br /> Mr.Trpj&ler <br /> ADDRESS Is'Q.I 1fC f le <br /> CITY,STATE,ZIP <br /> Std it+alnXA 95703 <br /> PHONE END DUMP BOTTOM DUMP. TR NSFER <br /> Z0r 454-1145 <br /> SIGNATUR F AUTHORIZED AGENT OR DRIVER DATq ROLL-OFFS FLAT-BED- VAN DRUMS <br /> ❑ a Us ❑ <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: DISPOSAL METHOD: (I O BE COMPLETED,BY LANDFILL)' <br /> DISPOS#= ,OTHER <br /> REMARKS 0 SOIL <br /> 63-CONSTRUCTION <br /> FACILITY TICKET NUMBS DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHO IZED A <br /> GEM DATE <br /> U WOOD <br /> ❑ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE WAbE PRIORTO3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY. DELIVERIES.MUST BE,SCHI^DULED WITH THE LANDFILL THE DAY BEFORE. <br /> 0ENCRATOR COPY MANIFEST# 41 <br />