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❑ Keller Canyon �, p Ox�Mountain r El Newby Island L1 f=orward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Batley Road_ ' 12310 Sari 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 /> Phone(925)458-9600 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 r <br /> Fax (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 /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> O GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> �^ ❑TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * qh)k� <br /> GENEP, fOR s CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper oondrtron for transportation a^cording to applicable <br /> regulations AND,"the waste Is a treatment residua of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrrclwns I certify 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 /> aC CFR Part 261 <br /> WASTE TYPE <br /> �)DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> _i DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> s$76 Country Curb Bled, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS f� S0 <br /> 5890 Elder r-mak Rd. <br /> CITY, STATE,ZIP <br /> CA 95828 <br /> PHONE END P BOTTOM DUMP TRANSFER <br /> 1111A (3 Q Q <br /> SIGNA OR14ED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 1 I ��23-f�3 ❑ ❑ ❑ ❑ <br /> �k <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been '18 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 /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER , <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM 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* 52925 <br />