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L-1 Keller Canyon ❑Coffin Butte " ❑Ox Moaarltain", ❑-Newby Island �rward <br /> Sanitary Landfill Landf Lv Sanitary LandfillQiDixon <br /> itary Landfill <br /> 901 Bailey Road 28972 Cofftl utte Road 12310 San Mateo Road Landing <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Raa• f � g S Austin Road <br /> Half Moon Bay,CA 94013 Milpitas, CA 95035 Mattfeca,°'�A"9�36°�-'"'� <br /> Phone(925)458-9800 Phone-(541)745-2018 Phone.(650) 726-1819 Phone(406)945-2800 Phone(209) 982.4298 <br /> Fax(925)458-9891 Fax (541Y745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZ ®OUS WASTE MANIFEST`' r <br /> GENERATOR <br /> fASTE ACCEPTANCE NO. <br /> MAILING ADDRESS f <br /> CITY,-STATE ZIP Y` REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> r4 r <br /> PH ^GLOVES., I1 GOGGLES Q RESPIRATOR U' RD HAT <br /> w - r •° K r C!TY-VEK p-eAPETY VEST <br /> (TACT PE �i ! ` <br /> SPECIAL HAND <br /> ,^ L NG PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE. ' <br /> GENERATOR'S CERTIFICATION:I hereby certify that The above named maferial is not a fiaiardeus _ <br /> waste as defined by 40 CFR Part 261 or€ills 22 of the California code of regulations,has been properry �' _ <br /> described,classified and packaged,and is in proper conditicn for transportation a"cording to applicable <br /> regu€ation%AND,if the waste Is a treatment realdue of a previously restricted hazwdous waste <br /> subieet Is the Land Disposal Restrictions,I certify and warrant thal the waste bas been treated in... - RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR P yf�B and is no longer a hazardous waste as deli4ed by - <br /> 40 CFR Part 261:. a*`Tr <br /> WASTE :.,,,, <br /> _,P�L1ISPOSAL ❑SLUDGE <br /> " ❑CONSTRUCTION Q WOOD <br /> ❑DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY K <br /> TRANSPORTER NOTES: VEHICLE <br /> TENSE NUMBER TRUCK NUMBER � <br /> ADDRESS <br /> Yi& <br /> CITY, STATE,ZIP'. <br /> PHONE—N, �" END DUMP r BOTTOM DUMP TRANSFER <br /> SIGNATURE.OF-AUTHORIZED-AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> Ll ': ❑ ❑ <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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY.LANDFILL) <br /> - <br /> DISPOSE OTHER <br />{ EMARKS ❑SOIL i <br /> o CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> I O WOAD <br /> '''� f _•�., t ' Y ,.r Q ASH <br /> ' O SPECIAL OTHER <br /> SC& �34J1�6€ <br /> UST BE MAE)' CSI r l 5O :3]ti °�9.Tifi f i�1'F`I?COI T`t� )n ?�f-CT'E AlyI 4 i aCl aE�? D LOADS a € FSUBJECT <br /> TO R:EFO§AL Odrt ARFIRiA.L. OMG-VI d 6.Ai Y DELWF_rms sE lnwr 1 CC7F,IkkI IL i .V#1't':I HE LANDFILL.THE DAY BEFORE. <br /> MT f <br /> ANIr � ,. <br /> x <br />