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❑ Keller Canyon ❑ Ox Mountalrk, v_4; p Newby Island El Forward <br /> Sanitary Landfill "I `tani�i�lry 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 /> 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 <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Mary ;inchpz <br /> MAILING ADDRESS <br /> sfi <br /> CITY, STATE, ZIPREQUIRED PERSONAL PROTECTIVE UIPMENT <br /> PHONE <br /> Q GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> ❑TY-VEK Q OTHER <br /> CONTACT PERSON <br /> 1hr-Itall <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF ALffHORIZEDAGENT/TITLE DATE <br /> GE NE TOR 5 CERTI CATION I hereby certdy that ft above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California rode of regulations has been properly <br /> described classified end packaged and is in Proper condtbon for transportation a-cofding to appfrabie <br /> regulations AND H the waste Is a treatment residue of a previously rostyktiad hazardous waste <br /> subject to the land Disposal Resrn�ons f certify and warrant that Cie waste has been treated m RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 2fSB and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 7 DISPOSAL Q SLUDGE <br /> ZI CONSTRUCTION Q WOOD <br /> Z)DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRE Inc [C?O# <br /> CITY, STM�10W GFeele Rd <br /> 5828 <br /> PHON END BOTTOM DUMP TRANSFER <br /> PaA L) <br /> SIGNA E ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ~ C�-,F3 -1 ❑ L)Jr <br /> ❑ ❑ <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 <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED 8Y LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS Q SOIL <br /> C?CONSTRUCTION <br /> FACILITY TICKET NUMBER I DEBRIS <br /> PNON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT - DATE ASBESTOS <br /> O WOOD <br /> Q ASH <br /> O 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 Ik 52922 <br />