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e er c:anyon Ll ox-Mountain Lj Newby Island ❑ Forward <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 Halt Moon Say, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST r <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS -- <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTNE EQUIPMENTPROTECT <br /> PHONE rA 952n3 Stockton, ❑GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> a U TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CF_1RT1F1CAj:i6N I hereby certify that the ahwe named material is not a hazardous <br /> waste as defined by 40 CF Part 261 u Otte 22 of the California code of regulations has been properly <br /> scnhed <br /> deetristrfied and paciragad and rs to proper oonddron for transportation a-cording to applicable <br /> regulations AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> sublect to the Land Disposal Restocrwns I candy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> J DISPOSAL 4 SLUDGE <br /> :7 CONSTRUCTION O WOOL) <br /> 0 DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1 876 Country Club Blvd, Stockton, CA 952()3 <br /> TRANSPORTER NOTES I VEHICLF LICENSE NUMBI=R TRUCK NUMBBE`R <br /> ADDRE Inc <br /> Son$Tri 7,6f- Crook Rd <br /> CITY, S# , <br /> PHON GA 95929 END DU BOTTOM DUMP TRANSFER <br /> Cr U El <br /> SIGNA A ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 1$ 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 /> ❑SOIL <br /> REMARKS •CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> © NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> L <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL•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 0 52924 <br />