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❑ Keller Canyon ❑Coffin Butte . ❑Ox Mountain ❑Newby Island jF�orward . <br /> Sanitary:Landfill 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 94565 Corvallis,OR,97330 Half.Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)45879600' Phone{541)745-2018 Phone.(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 ..Fax(54`I)745-3826 Fax(650)726-9183: Fax(408)262-2871 Fax(209)982-1009 <br /> NON=HAZARDOUS WAS IE MANIFEST. <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> —7 <br /> CITY;STATE,ZIP u EQUI-RED PERSONAL PROTECTIVE EQUIPMENT <br /> ' LOVES U GOGGLES ❑ RESPIRATOR RMARD HAT <br /> PHONE �r <br /> 41 TY VEK- _0. - AFETY VEST <br /> CONTACT PERSON I <br /> SPECIAL HANDLING PROCEDURES: ' <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named materiat 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,clashed and packaged,and is in proper condition for transportation a-co�ng to applicable - <br /> regulations;AND,If the waste to a treatment residue of a previously restricted hazardous waste <br /> subject Whe Land Disposal Restrlctlons,-I certify and warrant that the waste has been treated in RECEIVING FACILITY ' <br /> _accordance whh the requirements of 40 CFR Part 260 and is no longer a hazardous waste as defined by - l <br /> 40 CFR Part 281. I ' <br /> WASTE -PE: <br /> :DISPOSAL U SLUDGE p <br /> ❑CONSTRUCTION O WOOD { <br /> *DEBRIS U. OTHER . <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY € <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> - - : <br /> ADDRESS. <br /> CITY,STATE,ZIP. <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 62117 r <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT RIVER DATE . —,; ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> * 1 <br /> CUBIC YARDS <br /> hereby certify that.the above named materiaFhas been. . <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (To BE COMPLETED BY 1 4N1]FILL) <br /> is true and accurate. <br /> l <br /> DISPOSE OTHER <br /> Q SOIL <br /> EMARKS, . <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> O ASH <br /> O SPECIAL OTHEmowedR <br /> • I <br /> SCHEDULING MUST 131E IsafADE PRIOR T0 3:00AK I H DAY PR*RT0 EXPECTED AR€ rVAL-ANY UNSCHEDULED ED LO.ADARE SUBJECT <br /> 7°O REFUSAL UPON ARRIVAL..ONGOING DAILY DELIVERIES MUST E E5C3 � LED I THE LANDFILL THE�D7AY..�B]EFORE. <br /> f69PNIF ST 9, 5.3 7 5 <br />