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❑ Keller Canyon ❑ Ox Mountain a +1awliv oy e�ea.oM - --- - <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 /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Rhone (925)458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone (209)982-4296 <br /> Fl,(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> { NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 475 C v <br /> MAILING ADDRESS <br /> CRY,STATE, ZIP REQUIRED PERSONAL PROTirGTIVE EQUIPMENT <br /> ! 0 GLOVES ❑GOGGLES 0 RESPIRATOR g0 HARD HAT <br /> PHONE 0 TY VEK 0 OTHER <br /> CpNTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUT ORIZED GE -TITLE DATE <br /> * a Contractor f None <br /> A/ <br /> GENERATU CERTI CATION I Xiec�ar�ufytcthe above named matartal is not a hazardous <br /> waste aide by CFR Part Malitomia code of reputations has been prapedy <br /> dpRbed daasi{pd And packagedrondition for Vansportatlon aroordmg m appNcahie <br /> nquleAbns AND.H waste is i nt of a previously restricted hazardous waste <br /> m tlx Lanq!brapasel Rea ions I cerhty and warrant that the waste has boon treated in RECEIVING FACILITY <br /> acocrdar5oe with tYfe requtrsmen of 40 CFR Part 2138 and is no!anger a hazardous waste as dahned by <br /> .acFRPartzst//7 Forw&rd Eandfi <br /> ll <br /> WASTE TYPE us in 11a. <br /> ❑DISPOSAL` 0 SLUDGE I i <br /> ©CONSTRUCTION UWOOD Manteca, CA 95336 <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> Am <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMB <br /> Jim Thorpe Oil Inc. P g�f� <br /> ADDRESS 3 , <br /> O. Box 357 <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 7-16- <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 /> OT <br /> 0 SOIL <br /> DISPOSE HER <br /> EMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTbARl2<ED AGENT DATE <br /> 0 WOOD <br /> 0 ASH NEW <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST E MAD IORTO 5:00 FRM THE DAY PRIORTO EXPECTED ARRIVAL aANY UNSCHEDULED LOADS ARE SUBJEC <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOR <br /> GENERATOR COPY MANIFEST# 2 8 0 8 9 9 <br /> t <br />