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Linener anyon LJCoffin,.8utte ❑Ox.Mountain 0 Newby Island ] Forward <br /> Sanitary6ndfii[V Landfill °r Stinitary Landfill .. SaQ7!Landing <br /> Landfill .Landfill <br /> 901 Bailey Road 28972.Coffin B J oad 12310 San Mateo Road 160Road 99 °7�listin" M ad; <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 me A 9533 <br /> Phone (925)458-9800 Phone (541) 745.2018 Phone(650) 726-1819 Phone (408) 945-2800 P one-(2A9 982-4 98 <br /> Fax (925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fa 91009 ! <br /> NON-HAZARDOUS WASTE MANIFEST <br /> tGENERATOR WASTE ACCEPTANCE N0, <br /> 1 <br /> NG ADDRESS ' <br /> 0&aft&Holly li e9905 <br /> STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ThteyCA 9.5304 ❑ GLOVES ❑ GOGGLES ❑ RESPIRATOR " iI HARD HAT." <br /> PHONE � ' <br /> . i <br /> 09) ❑ TY-VEK LKSAFETY"VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE.OF=AUTHOR[ZED AGENT/TIT .E A JDATE }� <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous - I <br /> "waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly .f <br /> described,classified and packaged,and is in proper condition far 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 ,CER P.art.268 and,is no longer zardous a.hawaste as,d.eflned by'. ! <br /> (y 40 CFR Part 261. <br /> WASTE -YPE: <br /> y <br /> ❑':CONSTRUCTION ❑WOOD <br /> O DEBRIS ❑OTHER e <br /> ❑SPECIAL WASTE <br /> GENERATING,FACILITY <br /> TRANSPORTER"-.' ....'. NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> .l!au8t y <br /> ADDRESS EJ <br /> CITY, STATE,,ZIP <br /> PHONE-.,. _^END-DLIM 60TJOM_D-UMP. -.-'T <br /> ;r 0 _ <br />' SIGNATURE OF AUTHORIZED AGENT"OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS " <br /> CUBIC.Y flDS <br /> _�.I hereby certify that th:e,:....�..-.�.: <br /> above named material has been. <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Js true`and accurate. <br /> DISPOSE OTHER <br /> ❑SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION " <br /> FACILITY TIC T NUMBER DEBRIS <br /> ❑ N N-FRI BLE <br /> A BESTS . <br /> SIGNATURE PF AUTHORIZE AGENT . DAA <br /> COD <br /> 1 / 0 A3H <br /> ❑ SPECIAL OTHER " J <br /> .. SCHEDULING MUST 13E MADE PRIOR T 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON-ARRIVAL.ONIgIING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> Rev 11109 NS-024 TRANSPORTER COPY MANIFEST# :1� <br />