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❑ Keller Canyon ❑Coffin Butte ❑Ox Mountain ❑ Newby Island IN Forward <br /> Sanitarrl.Landfill Landfill Sanitary Landfill Sanitary. Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Malec,Road- 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Halt 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 /> MAILING ADDRESS _ <br /> .40.1.r W. iii .U.t ur 610" 9 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES ❑GOGGLES ❑RESPIRATOR INU HARD HAT <br /> PHONE <br /> (2(ija')41.69-0625 O TY VEK a SAFETY VEST <br /> CONTACT PERSON <br /> Bsdi1 ec"uJfact>t 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 /> 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 /> 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 266 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261. <br /> WASTE TYPE: <br /> �b DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION O WOOD <br /> U DEBRIS OOTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER. NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ✓ 0-7 ' <br /> ADDRESS r <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ <br /> Q. ❑ ❑ <br /> CUBIC YARDS <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 /> ❑SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FR <br /> ASESTOSLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MOST 13E MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAIL-UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE"DAY BEFORE. <br /> GENERATOR COPY MANIFEST# /9 <br /> .b.� `^t��L <br />