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El Keller Cany.orh El Coffin.Butte ElOx Mountain LJ Newby'lsland kJ Forward <br /> Sanitary Landfill Landfi�' Sanitary Landfill `;,nitary Landfill Landfill <br /> 901 Bailey Road 28972 CO Butte Road 12310 San Mateo' Road `rd�1 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) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NOC' <br /> M ILING ADD ESS <br /> 26]050 St Hv)I Drive 971905 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE CXGLOVES ❑ GOGGLES ❑ RESPIRATOR V HARD HAT <br /> M$34-7679 ❑TY-VEK WAFETY VEST <br /> C N ACTPERSON <br /> Ame On* SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 3 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named materia}isnot 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 according 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 288 and Is no longer a hazardous waste as dePned by <br /> 40 CFR Part 261. <br /> WASTE TYPE: L <br /> -ET51SPOSAL ❑SLUDGEA&I9-: <br /> ❑CONSTRUCTION U WOOD i <br /> ❑DEBRIS ❑OTHER i <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20509SM(h)iifquy]C dVe T' A CY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS M&56 <br /> CITY, STAT IF <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ZJl__ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> �y / ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY T KET NUMBER DEBRIS <br /> ' A <br /> xf I ❑ NON-FRIABLE <br /> ERESTOS <br /> SIGNAT REO ; AUTH, IZED AGENT D TE-Z-1W 00� <br /> ❑ SH `l <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MJI60RIIOR TO 3:00 P,M.THE DAY PRIOR TO EXPECTED ARRIVAL+ANY UNSCHEDULED LOADSARE SUBd r : <br /> TO RECUSAL UPON AR 1 L.ONGOING DAILY DELIVERIES MUST DE SCHEDULED WITH THE LANDFILL THE DAY BE1 <br /> , <br /> NS-024 MANIFEST T <br /> Rev,trios: r k <br /> e� . <br />