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LJKelier Canyon LJCoffin Butte ❑Ox Mountain ❑Newby Island ] Forward <br /> Sanitary Landfill Landfill `Sanitary Landfill Sar�."ry Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Bu a Road 12310 San Mateoa.Road 1601�xon 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 /> t <br /> RATOR WASTE ACCEPTANCE N0.C ADDRESS ���3 3 $o I)tive —TATE, ZIP" . REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CA9S3 <br /> PHONE. CXGLOVES ClGOGGLES ❑ RESPIRATOR X HARD HAT <br /> (21119)W44-7679 ❑TY-VEK C$SAFETY VEST <br /> CON .ACT PERSON <br /> Awe 0my t SPECIAL HANDLING PROCED13RES: j <br /> SIGNATURE OF-AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above n ed material is not a ha2ardous <br /> waste as defined by 4D CFR Part 261 or title 22 of the CaVornia ccAe of regulatfcns,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 th_a requirements of 4D G Part 268 and is.no longer a ha_zard_ous waste as defined_by <br /> -40 CFR Part 261. - - x- _—' - - <br /> WASTE E <br /> S OSAL ❑SLUDGE <br /> `"❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 205W South$ally Dive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBERI TRUCK NUMBER <br /> ADDRESS <br /> Po!st rtmee B=3517 <br /> CITY, STATE, ZIP <br /> F,o&VA 95241 <br /> PHONE —_._._END.DU.MP BOTTOM_DUMP_ TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> "I hereby certify that the above"named"material •has been " <br /> E accepted and to the best of my knowledge the foregoing <br /> IS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> i ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGN TURF_ OF AUTHORIZEp AGENT r DATE <br /> A AS 1 <br /> i <br /> ❑ SPECIAL OTHER <br /> I <br /> SCHEDUL G MUST BE MA0E PRIOR TO 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 /> I Rev 11/49 NS-024 GENERATOR COPY MANIFEST# - - 1 :V <br />