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Keller Canyon ❑Coffin BU ' ❑Ox Mountain Ll Newhy Island 7 Forward <br /> San! Landfill Landfill Sanitary Landfill . Sar, ry Landfill Landfill <br /> y s .. i <br /> 901 Bailey Road 28972 Gotthr Butte"'R&d-d 12310 San Mateo Road 1601 Dixon Landing Road Manteca, <br /> S. Austin Road <br /> Pittsburg, GA 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) 98 <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 WASTE ACCEPTANCE NO. <br /> S <br /> MAILING ADDRESS +_ —. 9905 <br /> -20500;'it h Ho I3riv6, <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE�EQUIPMENT <br /> CA 5 MLOVES U GOGGLES © RESPIRATOR 7i►".l HARD HAT <br /> PHONE O TY-VEK CSAFETY VEST <br /> CONTACT-PERSON SPECIAL HANDLING PROCEDURES: <br /> :. Aerie 0 <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> rn,1 /r <br /> •!hereby cerci that the above nam d material is not a hazardous : <br /> GENERATOR'S CERTIFICATION. y_ ty - <br /> �:'� waste as defined by 40 CFR Part261 or title 22 of the California code of�ogulatlons,has been propene - <br /> described,classified and packaged,and is in proper condition for transportation according to app.' • �:. <br /> 'regulaHons;ANI),•tt..the waste Is a treatment residue of a:prevfously restricted hazardous waste RECEIVING FACILITY - <br /> - ,...,. <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has treated e -e ..w:. <br /> .accordance with the requirements of 40 CFR Part 268 and is no ionger a hazardous waste as defined by - <br /> t-> <br /> 40 CFR Part 261:' --•_-�-.--._.v.w .. - . ' <br /> G' <br /> SPOSAL -', ❑SLUDGE <br /> CONSTRUCTION D WOOD <br /> Q DEBRIS IJ OTHER <br /> ❑SPECIAL WASTE <br /> GENERATWG,41 <br /> FACILITY <br /> f. <br /> TRANSPORTER. <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER •; <br /> I ADDRESS <br /> C[TY STATE, ZIP <br /> END DUMP ' _BOTTOM DUMP -- :TRANSFER <br /> PHONE <br /> SIGNATURE OFAUT!IORIZED AGENT:OR DRIVER DATE: <br /> ROLL-OFF(S) FLAT-BED VAN DRUMS i <br /> D <br /> k, <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'BI(.LANDFILL) <br /> i is true and accurate. <br /> DISPOSE . O7k{ER <br /> ❑ SOIL <br /> REMARKS D CONSTRUCTION <br /> DEBRIS <br /> I FACILIX`7.TICKET NUMBER ❑ NON-FRIABLE <br /> ,. I ASBEST, S <br /> SIG AT RE OF AUTHO I ED AQENT 4ATE ❑ OD <br /> ! i <br /> n A H <br /> Y 1 <br /> ❑ SPECIAL THER <br /> ARRIVAL-*ANY UNSCHEDULED <br /> ARE <br /> CIr <br /> 00 P-M-THE DAY PRIOR TO EXPECTED <br /> SCHEDULING FAUST BE MADE pR! TO 3:G DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDF L L.THE DAY BEFORE <br /> TO.REFUSAL UPON ARRIVAL.fNGOIN MANIFEST#-S-.1116 2.1�_a -- <br /> t TRANSPORTER COPY <br />