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r<eiier anyon .0Coffin Butte I <br /> El Mountain ❑Newby Island ]Forward <br /> SanitaryLandfill Landfill ��` �'`Sanitary Landfill S€ ry Landfill Landfill <br /> 901 Bailey Road 28972 Goffltj' e F oal 12310 San Mateo,Road 1601 Dixon Landing Road 9999 S. Austin Road <br /> Pittsburg, CA 94585 Corvallis; OR 97330 Half Moon Bay 6A'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) 726-9983 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATfJR: WASTE ACCEPTANCE NO. <br /> A,1LIN ADDRES <br /> sa Irhive <br /> ITYi" E;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Alae CA 0536 . <br /> ,. PHONE S ::� '' CY-GLOVES C3 GOGGLES ' 0 RESPIRATOR M7 HARD) HAT <br /> 3' .r 0 TY-VEK CXSAFETY VEST <br /> CON AGT PERSQIV <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE bF AUTHORIZED AGENT/TITLE DATE <br /> GEK� TOR'S CERTIFICATION:I hereby certity that the above n ed material is not a hazardous <br /> ti rwaste ags deripeq b6 46 6FR Part 261 qr title 22 of the Califomia c' a of regulations,has been property - ! <br /> r ' described,clam$he and packaged,a0d_is'in pr per condition for transportation according to applicable - <br /> regulations;AND;If the waste Is <br /> ,a treatment residue ot a previously restricted hazardous waste - - - <br /> - Subject-to the,Land Disposal Restrictions,I certify and warrant that the waste has been treated Tn RECEIVING FACILITY . <br /> xaccordance with.1he.requireinents of,40. Part 288 andisno longer a hazardous waste,as defined by­ <br /> 40 CFR Part 261. -- <br /> r' e <br /> WASTE E: _ F <br /> ©CONSTRUCTION Q WOOD' t f <br /> 0 DEBRIS Q OTHER - ;, #, . <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20506 iou&Hog*-D&e TRACY <br /> _ - TRANSPORTER NOTES: VEHICLE•LICENSE NUMBER' TRUCK NUMBER' • ' ,:' <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> LodiLCA 95141 <br /> PHONE _END-D.UMP =�'. .O_TTOM RUMP TRANSFER <br /> Lj o <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT BED ' VAN DRUMS <br /> r <br /> - o a <br /> CUBIC YARDS <br /> 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 BYLANDFILL):is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS o SOIL <br /> r o.CONSTRUCTION <br /> FACILI TICKET.NUMBER DEBRIS <br /> 0 NON-FRiABLE <br /> SIG1�lATURE OF AUTJ'IORIZE0 AGENT DATE ASBESTOS <br /> i _❑ AS r <br /> I 0 SPECIAL OTHER 1 <br /> $CP9EDU G MUST BE MAVE 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 LA[aDFILL THE DAY.BEFORE. r <br /> Rev 11/09 NS-024 TRANSPORTER COPY MANIFEST.#� : <br />