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❑ Keller Canyon <br />Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-98.91 <br />❑ Coffin Butt <br />Landfill <br />28972 Coffin Butte Road <br />Corvallis, OR 97330 <br />Phone (541) 745-2018 <br />Fax (541) 745-3826 <br />❑ Ox Mountain <br />Sanitary Landfill <br />12310 San Mateo Road <br />Hall Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />❑ Newby Island <br />Sanitary Landfill <br />1601 Dixon Landing Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <br />Fax (408) 262-2871 <br />1 Forward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />EIvERATOR <br />wAsm ACCEPTANCE NO. <br />Joaquin, County o <br />MAILING ADDRESS <br />- 6881 <br />CstBox 1810 <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE E UIPMENT <br />'° ` n, ' <br />GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br />PHONE <br />209) 468-3066 <br />O TY VEK SAFETY VEST <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />e Perez <br />SIGNATU OF AUTHORIZED AGENT ! TITLE DATE <br />TOR 3 COMMAWW i hereby ce4o Mal Ore aim mmned malarial is not a hamdm <br />as defined by 40 CFR Part 261 or Ode 22 of ft Cafifornia cad of tegWafions, has been properly <br />pad aped, and is in proper condition for hanspmumon av"ding b appficable <br />AM H On waste Is a residue of a previously waste <br />mliw to no land Disposal i carby and warrant that Bte waste has been heated In <br />RECEIVING FACILITY <br />accmdancs war 0te recuhements of 40 CFR Part 268 and is no bogey a hazardous wage as defined by <br />40 CFR Part 261. <br />WASTE TYPE:r� <br />1 G4a1 C4 C €o 4.0`I a-,�- . <br />�- <br />O DISPOSAL O SLUDGE <br />J # ' S <br />O CONSTRUCTION O WOOD <br />p/' <br />O DEBRIS O OTHER <br />i � .2 � 9 <br />O SPECIAL WASTE <br />7� r :2 <br />-14,— <br />GENERATING FACILITY <br />17720 F. Harney 1.,ane _ P04000001303-5 LODI <br />TRANSPORTER <br />NOTES: VEHICLEp�LICENSE NUMBER TRUCK NUMBER <br />Container Corp <br />[�f. <br />ADDRESS <br />dT <br />145 W. Charter Wk <br />CITY, STATE, ZIP <br />'1r4 , v _ F <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />} 2e6 c19 <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br />ROLL -OFF S FLAT-BED VAN DRUMS <br />i}P, <br />❑ ❑ ❑ <br />f <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. <br />®1r3P® ME fHAD; (To ori, cGia►PL® t,�weFl <br />DISPOSE OTHER <br />)WbOIL <br />EMARKS <br />O CONSTRUCTION <br />FACILITY TICKET NUMBER <br />DEBRIS <br />O NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT DATE <br />O WOOD <br />/ <br />O ASH <br />O SPECIAL OTHER <br />SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />GENERATOR COPY MANIFEST #, <br />�.. <br />