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[:] Keller Canyon ❑ Ox Mountain LJ JVV%V.,y 6.71iws,ee - <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road. 1601 Dixon Landing Road 9999 S Austin Road <br /> CA 94565 Halt Moon Say,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Pittsburg, Phone(650)726-1 B19 Phone(405)945-2800 Phone (209)982-4298 <br /> lkhone(925)458-9800 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> �c <br /> F (925)458-9891 <br /> r <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS — ,,Z <br /> CITY,STATE,ZIP Go REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> E O GLOVES 0 GOGGLES O RESPIRATOR g0 HARD HAT <br /> PHONE O TY-VEK 0 OTHER <br /> CpNTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUT ORIZED GF TITLE DATE <br /> Contractor 7 �� (f None <br /> t <br /> A. <br /> pgllEpgTp CER'TI CATION I M certify t the above named material is not a ttaurdoua <br /> w RM ss de by 4PFCFR Part 261 Ile 22 O camomia code of regulations has been properly <br /> a gibed dnaaif ad fnd pacmi; d is in r oondnion for transportation a^cordmg to appWade <br /> r�puleaiwrs AND,it waste 1rions <br /> t w of a prwbuaty rastrlcted hsmrdous wants <br /> z vsj m me tarXplaposef Rertify end warrant that the waste has been tma*d m RECEIVING FACILITY <br /> aacoordenoe with a requlromen Part 268 and isno toriger a hazardot,a waste as dehrwd by F o r W ar an 1 <br /> •0 M Part 261 <br /> WASTE TYPE 909V 6. RUSTIn ha. <br /> •DISPOSAL` O SLUDGE <br /> •CONSTRUCTION •WOOD Manteca, CA 95336 <br /> O DEBRIS ❑OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> Ask <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMB <br /> EW <br /> Jim Thor a OSI Inc. -3p 93/0 <br /> ADDRESS = , <br /> P.O. Box 357 <br /> CITY,STATE,ZIP <br /> T,ndi _ CA 95241-0257 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 7-16-1 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> O SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILFFYTICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTVORIZED AGENT DATE <br /> •WOOD <br /> I /� '° <br /> 0 ASH <br /> / 0 SPECIAL OTHER <br /> SCHEDULING MUST kE IWIORTO 8:00 R M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJEC <br /> TO REFUSAL UPON AIMIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOG <br /> GENERATOR COPY MANIFEST* g R n R q 9 <br />