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U Keller Ganyon L l Coffin Butte LJ Ox Mountain L1New[ ys"anu r <br /> Sanitary Landfill Landfill Sanitary Landfill S;- ar Landfill <br /> 901 Saiiey Road 28972 Coffin Comte Road 12310 San Mateo Road 16C1'C)ixalZ Landing Rf?atl 3'.• <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, GA 95035 <br /> Phone (925) 458-9800 Phone (541) 745.2018 Phone (650) 726-1819 PI)one (406) 945-2800 FII +I <br /> Fax (925) 458-9891 Fax (541) 745-3826 Fax(650) 726-9183 Fax (408) 262-2871 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS__ " <br /> F.',�:7 t;'t�"��•a rr#�,�rg+,'tFjl �-;i.?'ti ,. _ _ ..-...-i <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE " <br /> j.GLOVES D GOGGLES _3 RESPIRATCY', ` <br /> PHONE <br /> r J TY-VEK 2.SAFETY VEST <br /> CONTACT PERSON <br /> -- SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHOR IZFt:3 AGENT 1 TITLE DATE <br /> l <br /> GENERATOR'S CCRTIFICATION.I hemily certify Ihat lire above named materiel is riot a hazardous <br /> waste as definer)by 40 CFR Furt 261 or title 22 of the Caliromia curie of legulalions,has beer properly 1 <br /> desrribe[i,elassihed'[ltd packaged,and is in piopor condition for transpodation according to applicable <br /> regulations,AND,If the waste is a treatment residue of a previously restricted hazardous waste - --- - -- - - <br /> subject to the Lard Disposal Ftcsw(iinns.I Certi!y and warrant That the waste has been treated in RECEIVING FACILITY <br /> EinCerdence will,the requirements of 40 CFO Part 768 end is ro longer a ftazardous waste a5 defined by <br /> 40 CFR Part 261 - ' <br /> WASTE TYPE: - — -- — — - —.. <br /> J SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER T i <br /> U SPECIAL. WASTE -- - <br /> - - I <br /> GENERATING FACILITY - - <br /> ') C.9lr t 4N t;.qE.. Y7-' L:R'1 S' . -,'?.Y•.ii., ------..� ---- ._.. ----- <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER <br /> ADDRESS <br /> CITY,STATE, ZIP <br /> I <br /> PHONE END DUMP BOTTOM DUMP <br /> — - _I <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL OFFS) FLAT BED - Vi`?,i l <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been r' <br /> accepted and to the best of my knowledge the foregoing - - <br /> i5 true and accurate. DISPOSAL METHOD: (TO BE COMPLETED <br /> DISPOSE <br /> J SOIL f -- - -- - --i <br /> REMARKS ----- -- ---- <br /> --— U CONSTRUCTION <br /> -- DEBRIS <br /> FACILITY TICKET NUMBER U N0N-FRIA3LE <br /> ASBESTOS <br /> SIGNAT.URF_ OF AUTHORIZED AGENT DATE —�--- - <br /> ❑.WOOD' <br /> J ASN <br /> -- J SPECIAL OTHER I <br /> 7 <br /> SCHEDULING MUST 81E'AADE PRIOR'TO;I:®A P.M.THE DAY PRIOR TO EXPECTED ARRIVAIL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. O,N4135ANG DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> F'ov 11;09 NS-024 f' GENERATOR COPY MANIFEST It <br />