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LJ Keller Canyon LJ Coffin Butte LJ Ox Mountain LJ Newby Island k Forward U Keller Canyon U Coffin Butte LJ Ox Mountain LJ Newby Island k1 Forward Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill 901 Bailey Road 28972 Coll Butte Road 12310 San Mateo Road 1601 Dlxcn Landing Road 9999 S.Austin Road 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road Pittsburg,CA 94565 Corvallls,OR 97330 Half Moon Bay;CA 94019 Milpitas,CA 95035 Manleca•CA 95336 PltlShurg,CA 94565 Corvallis,OR 97330 Half Moon Bay;CA 94019 Mllpitaa,CA 95035 Manteca,CA 95338 Phone(925)458-9800 Photo(541)745-2018 Phone(550)726-1819 Phone(408)945-2600 Phone(209)982-4298 Phone(925(458-9800 Phone(541)745-2018 Phone(650)72&1819 Phone(408)945-2800 Phone(209)982-4298 Fax(925)458-9691 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262.2871 Fax(209)982-1009 Fax(925)45B-9891 Fax(541)745-3626 Fax(650)726-9183 Fax(408)262-2871 Fax(209)9B2-1oo9 NON-HAZARDOUS WASTE MANIFEST NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. [GENERATORWASTE ACCEPTANCE HO.M (LING ADD ESS ��5 ILING ADD ESS 39Q5 20500 S;oulh H*Drive U 0 CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT I�GLOVES O GOGGLES 0 RESPIRATOR 70 HARD HAT pXGLOVES 0 GOGGLES ❑RESPIRATOR PHO E PHO E J0 HARD HAT mm R14-7= ❑TY-VEK CXSAFETY VEST ❑7Y•VFK CXSAFETY VEST C N ACF PERSON SPECIAL HANDLING PROCEDURES: C N ACT PERSON LSPECIALANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT/TITLE DATE SIGNATURE OF AUTHORIZED AGENT/TITLE DATE GENERATORS CERTIFIC/�TiON:lhereb..*Nei lPe abure 6enle iYNrBrlBlkmta hemr�ve GENERATORSCERT] lT10N:I MrabyTfY dwt the ebew lnekrlel k nota haea-1 ud OmdbyGAND, pg , pW � eaeeQnebsaQ aatl peCKaged,LMunProger wntllllon for IrarAN[1,If Ne wale Ie•Ireatmentrwltlua e!a prevlauNy reerrfeeetl hazertleua ween repulatiwn:ANGfl Ne waste Ie a ireatmnr realtlue of a rnlouelyRECEIVING FACILITYerireea 'tlanee wrm ms requdarn.nrc el aP epRp.axes ens lemlmpara nanraoue'.estaudenmd� __ __ -__ _ _ meas me raqulremameU UFR Pen e68 enbkmlon,,era hujwade ae an j RECEIVING FACILITY w CFR PBR 28t. � 10 CFA Pen261. :F� WASTE TYPE: �,, 7� WASTE TYPE: POSA Li SLUDGE _-- �6�• POSAL Cl SLUDGE ❑CONSTRUCTION ❑WOOD p CONSTRUCTION ❑WOOD •DEBRIS d OTHER 0 DEBRIS O OTHER ❑SPECIAL WASTE 0 SPECIAL WASTE GENERATING FACILITY GENERATING FACILITY 20500 Son&Hoffy Drive TRACY 20500 Booth Roily Drive TRACY TRANSPORTER NOTES: VEHICLE LICENSE NUMBER T UCK NUMBER TRANSPORTER NOTES: VEHICLE LICENSE NUMBER T LICK NUMBER ADDRESS ADDRESS C PHONE END DUMP_ BOTTOM DUMP TRANSFER PHONE END.DUMP BOTTOM DLIMP TRANSFER ❑ ❑ U ❑ SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFP) FLAT-BED VAN DRUMS SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS ❑ ❑ ❑ ❑ / ❑ ❑ ❑ ❑ CUBIC YARDS CUBIC YARDS I hereby certify that the above named material has been I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing OD: (TO BE COMPLETED BY LANDFILL) accepted and to the best of my knowledge the foregoing DISPOSA METHDISPOSA MET Is true and accurate. is true and accurate. HOD: (TO BE COMPLETED BY LANDFILL) DISPOSE OTHER DISPOSE OTHE ❑SOILD SOIL —i REMARKS REMARKS 0 CONSTRUCTION O CONSTRUCTION FACILITY TICKET NUMBER DEBRIS FACILITY TICKET NUMBER DEBRIS ❑NON-FRIABLE ❑NON-FRIABLE SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS J WOOD O WOOD ❑ASH ❑ASH SPECIAL OTHER - * - 0 SPECIAL OTHER ' SCHEDULING MUSTBE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADSARESUBJECT SCHEDULING MUST BE MADE PRIOR TO3:00P.M.THEDAY PRIOR TOEXPECTED ARRIVAL-ANY UNSCHEDULED LOA DSARESUEJECT TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, Rev 11109 NS-024 GENERATOR COPY MANIFEST,,H 2.0'17 Rev 11!09 NS-02a67�2.0 7 GENERATOR COPY MANIFEST;y I• �3 L