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'❑ Keller Canyon ❑.Coffin Butte ❑Ox Mountain ❑ Newby Is A Forward <br /> .Panitary j-andfill 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 9.4565 " 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 N0. <br /> Heada»tg-I��x1r <br /> tcn <br /> MAILING ADDRESS <br /> ve <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT j <br /> "0A956GLOVES O GOGGLES ❑RESPIRATOR Q HARD HAT <br /> PHONE <br /> 2 469-0625 ❑TY-VEK O SAFETY VEST <br /> CONTACT PERSON <br /> Fr t.Catl" 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 properly <br /> desbribed,classified and packaged,and is in proper condltidn for transportation a-cording to.applicable <br /> regulations:AND,If the waste is a treatment residua of a previously restricted hazardous waste. <br /> subject to the Land Disposal Restrictions,I csrtity 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 GFR Part 261. <br /> WASTE TYPE: <br /> 1 DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION ❑WOOD .. <br /> ❑DEBRIS a OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W,Hwelttm Ave MCKr0 1%T . <br /> TRANSPOFITER NOTES: VEHICLE UCENSE NUMBER TRUCK NUMBER <br /> Mr.'17rfa t'r <br /> ADDRESS <br /> 2710 L-mmis Rand <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2 56.1145 - <br /> ❑ ; <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE 'ROLL-OFF S ' FLAT-BED VAN DRUMS <br /> * %rd <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been A <br /> accepted and to the best of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD: (TO BE CoAPLOP-D BY LANDFILL). <br /> DISPOSE OTHER. <br /> E<MARKS <br /> Q SOIL : <br /> CONSTRUdTION.' <br /> FACILITY TICKET NUMBER DEBRIS : <br /> O NON-FRIABLE . <br /> ASBESTOS <br /> SIGNATURE OFAUTH RIZEDAGENT DATE <br /> ❑WOOD <br /> CI SPEOIAI&HER <br /> SCHEDULING.MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECT O ARAI.VAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY" DELIVERIES MUST BE §6HHE,6 LED WITH"THE"LANDFILL THE DAY BEFORE: " <br /> ° GENERATOR COPY MANIFEST# .; 8 <br /> \ w <br />