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Keller Canyon ❑Coffin Butte ❑Ox Mountain El Newby Island ]Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mated Road 1601 Dixon Landing Road 9999 S.Austin Road <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)945-2600 Phone(209)982-4298 <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 WASTE ACCEPTANCE NO. <br /> MAILING ADD ESS — <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> M=-CA 25-40A =LOVES ❑GOGGLES ❑ RESPIRATOR )p HARD HAT <br /> PHONE . <br /> ❑TY-VEK WAFETY VEST <br /> CIONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> :GENERATOR'S CERTIFICATION:I hereby certtty that the above named materiat is not a hazardous <br /> 9rasts es t1efNlBd by 40 CFR Pan 261 or#ft 22 of the Camomia coda of regutabons,has been property <br /> desorlbed,claee[6ad and padm9ed,and Is in proper cond lonfor trahsportatkm according to appficabfe <br /> re9ulso";AND,tf tlw west's b a twetmaM nmddue of*preylously r eaUtd6d hazardous waste <br /> atom to the Lend bisposM Plestrie6ons,I certify and wa the waft hsa been treated In RECEIVING FACILITY <br /> aacadanea with the requirernerrrs of 40 CFR Part 288 and is... nger a hazardous waste as defined by <br /> 40 CFR Pad 261, <br /> WASTE TYPE: <br /> SPOSAL Q SLUDGE <br /> ❑CONSTRUCTION Q WOOD <br /> ❑DEBRIS Q OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> 205W Saab H04 Derive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> ftd 011150 6!99 352 <br /> CITY, STATE,ZIP <br /> T&&CA 95241 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL.-OFFS FLAT-BED VAN DRUMS <br /> p ❑ ❑ ❑ <br /> ♦ I <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 BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY CKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> BESTOS <br /> SIGNA URE OF AUT I E A NT D <br /> 0 kOOD <br />