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❑ Keller Canyon T.,.0 Ox-Moun#Ikin ❑Newby,141W Forvv4>�t,�t� <br /> v Sanitary Landfill Sanitary Landfill Sanitary L> rid � L6n�if��( ' <br /> 901 Pailey Road 12310 San Mateo Road 1601 pawn Likhding @Sqd 9998 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,Ca 94019 Milpitas,CA 8568 IUIRnea Cq'936 <br /> Phone-(926)458-9800 Phone(650)726.1819 Phone(408)946-?800 Phone(209)'9$2-4298 <br /> Fax(925)458-9891 x(650)726-9183 Fax(468)26-2871 Fax(209}9824009 , <br /> _ NPN-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING A RESS <br /> 1633 W CITY, STATE ZIP REQUIRED PERSONAL PROTE UIPMENT <br /> PHONE Stocktan. CA 95203 0 GLOVES 0 GOGGLES O RESPIRATOR O HARD HAT <br /> S30 668-5399 ❑TY VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE QF AUTHORIZED AGENT/TITLE I DATE <br /> GEN OFt S CERTIFICATION 1 hereby oart![y that the above named materW is nal a Nmardous <br /> wa as decried by 40 CFR Part 261 or Tide 22 of the Cagffoml4 code of rapuladons has been properly <br /> seabed [dassl8ed and psAaged and Is in proper oondltion for transportation amordrp to app8rabb <br /> regulations,AND.N the waste is■traebnart residue of a previously restricted hazardous wast, <br /> sub=a the Land Disposal Restktlom,l carOV and warrant that the waste has been treated In RECEIVING FACILITY <br /> ' <br /> acoordar"wM ft requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> 0 DEBRIS O OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TManipky P. Sam Trunking Inc. <br /> RANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> . 22 <br /> ADDRESS <br /> 8896 Eiger Cmak Rd <br /> CITY, STATE,ZIP <br /> PHONE Sacoawe= CA 95828 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNAT A ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> , ' ❑ ❑ ❑ ❑ <br /> ,� "_' r�t�'"� ,/ �C '�Y.t 1.(".r1}r►� .:''.r,�J ~ S <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been IS Yards <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 /> EMARKS^ <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NU NON- <br /> ER ' DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNAIURE OF AU IZEDAGENT DATE <br /> O WOOD <br /> r AS <br /> * ' ❑ CIAL OT14FFi <br /> Now Now <br /> SCHEDULlk4 <br /> USf BE MApi PRIOR TO 3.00Px-mDAY F41ORTOEXPECTED ARRIVAL•ANY UNSCHEDULED LOADSARESUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DEL;!VEAIES MUST BE SCHEDUl,ED WITH "E LANDFILL Tilt; DAY'$EFORE. <br /> TRAN8POATER COPY. t- s c1_, f4- <br /> ST�F <br />