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LJ Keller'canyon LJ Coffin Butte LJ Ox Mountain LJ Newby Island Xi Forward <br /> Sanitary Landfill LandfQ Sanitary Landfill ' nitary Landfill Landfill <br /> 901 Baitey Road 28972 C 1 Butte Road 12310 San Mat6b Road "SOI 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 (408)262-2871 Fax (209) 982-1409 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADD ESS <br /> 2(ISQp Svt9h Ho I7rirve 9905 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 1MMCA 95304 <br /> PHONE ZXGLOVES ❑ GOGGLES ❑ RESPIRATOR 30 HARD HAT <br /> ❑TY-VEK LISAFETY VEST <br /> CON ACT PERSON <br /> Anne QMy 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 haza'r&ous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Celtfomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable 1 <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste jl <br /> subject 10 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 d1fined by <br /> 40 CFA Part 261. <br /> WASTE TY.E: <br /> POSAL ❑SLUDGE <br /> CONSTRUCTION U WOOD ; <br /> O DEBRIS ❑OTHER --- <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 201 8v�&Holly ridye TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE—, Z <br /> WA 95241 <br /> i <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ a ❑ ❑ <br /> CUBIC YARDS <br /> 1 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. SADISPOL METHOCr: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS 11 <br /> ❑ NON RIABLE I <br /> SIGN 4`URE OF AUTHOR l3A ED AGENT E- sros <br /> ❑ SPECIAL OTHER <br /> v <br /> SCHEDULING MUST BE MADE/A!61111 TO 3:00 P.M.THE DAY"PR1dR TO 010ECTED ARRIVAL•ANY UNSCHEDULED,LOADS ARE SUBJE�y <br /> TO REFUSAL UPON ARRIVIAL."OhICOLNQ DAILY DELIVERIES MUST:6E-SC6IEDULED WITH THE LANDFILL THE DAY BEFOrM <br /> , <br /> 99Y 1/09 Ns-1?2a 'GENERATOR COPY NEANIFEST# I; }. x.< <br />