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LJKeller canyon LICoffin Butte ❑Ox Mountain ❑Newlay. Island Forward <br /> Sanitary Landfill LandfillT Sanitary Landfill Sar" #,y Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Bu a Road 12310 San Mateo Road 160on Landing Road AM'&Austin E�oad <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 (209982-_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 /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADD ESS ���� <br /> 20500 Sop&No Drirve <br /> CITY; STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT I <br /> HOTr <br /> 'hiCXGLOVES ❑ GOGGLES ❑ RESPIRATOR 31 HARD HAT <br /> PHONE 3 <br /> (202)RAA.7679 ❑ TY-VEK C$SAFETY VEST f <br /> CON ACT PERSON <br /> Anse SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE. DATE <br /> 2f7' / r <br /> GENERATOR'S CERTIRCATIDN:I hereby certify that the above named aterial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the,Calliomia code of regulations,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.the.requirements of 40.CF 268.and.is no longer a,hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TY <br /> D CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER e <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 Soudi Holly Ddve TRACY <br /> TRANSPORTER_. NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AM 1horpe N1 Eac <br /> ADDRESS <br /> pod CITY, STATE, ZIP <br /> JAA,VA 95241 <br /> -� PHONE —END.D.0 __---_BO_TTOM_DUMP— _TRANSFER <br /> ❑ Ll- <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE L-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ J. ❑ <br /> l <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> i accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL MET OD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY TI KETrNUMBER DEBRIS _ <br /> F ❑ NON-FRIABLE <br /> { I f AS EST S <br /> SIGNATU E OF JUTHOR ED AGENTN 47 E. <br /> ❑ A H <br /> f <br /> ❑ SPECIAL OTHER <br /> E ' <br /> SCHEDULING MUST BE MADE PRIOR O .S <br /> 3:00 P.M.THE DAY PR[OR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS AREUBJECT <br /> TO REFUSAL UPON ARRIVAL.ONLNG DAILY DELIVERIES MUST 13E SCHEDULED WITH THE LAN DFILL.THE DAY 8EFORE. <br /> Rev 11/09 NS-024 GENERATOR COPY <br /> MA4V]FEST# 6.4 <br />