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II ❑ Keller Canyon ❑Coffin B"Utte ❑Ox Mountain ❑ Newby Island FX Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12314 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(448)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 1-1cw1w at C1.R m.ktrco"s <br /> MAILING ADDRESS _ 609 <br /> ZV45 W, <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> `�r'1x_x ftc 7A 95I(!s <br /> PHONE �GLOVES ❑GOGGLES d RESPIRATOR �Q HARDHAT <br /> O.C�'�')469_015i�1: ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> arc#t�'raT1x �:1 SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1'TITLE DATE <br /> E <br /> GENERATOR's CERTIFICATION:I hereby certify that The above named malarial is not a hazardous <br /> waste as defined by 40 GFR 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-carding to applicable <br /> regulations;AND,It 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 268 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261. <br /> WASTE TYPE: <br /> A5 DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ID WOOD <br /> O DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> ZW_: W,lft-eltcyll 'A:,rt; <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 14.r,Tvickcr <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> RHONE END DUMP BOTTOM DUMP TRANSFER <br /> f Z�*14515-1145 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUM <br /> CUBIC YARDS <br /> I I 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 /> Z3 SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTIJORIZED AGENT DATE---, <br /> ❑WOOD <br /> 4 ASH <br /> 1 ;1v v tr <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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 /> 13ENERATOR COPY MANIFEST# ` " <br /> u, <br /> �.:04J3 1 <br />