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Keller Canyon ❑ Ox Mountain El Newby Island ❑ Forward <br /> Sanitary Landfill SAnitary Lindfill``��' t �`l"'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 /> L,A <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> PHONE O GLOVES 0 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> t;,a ❑TY-VEK 0 OTHER <br /> CONTAPERSON <br /> CT SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFA THORIZED AGENT/TITLE DATE <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or btla 22 o1 the California code of regulatwns,has been property <br /> described tdassified and packaged and is in proper condtlion for transportation Aloordtrq to applicable <br /> regulations AN4 it the waste is a treatment residue of a previously rozh ictDd hazardous waste <br /> subjectut�a it d Dtsposal Restnetions I certify and warrant that the waste has boon treated In RECEIVING FACILITY <br /> 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 /> �DISPOSAL ❑SLUDGE <br /> Z)CONSTRUCTION 0 WOOD <br /> Z)DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1870 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLES 7LICENSE NUMBER TRUCK NUMBER <br /> ADDRE Inc <br /> CITY, ST P <br /> CA 9828 r_ <br /> PHONE END DU BOTTOM DUMP TRANSFER <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUZ QMS <br /> A// <br /> Ll <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 DISPOSALMETHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS D SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHOR IZED AG ENT DATE r ASBESTOS <br /> O WOOD <br /> ❑ASH ' <br /> ❑SPECIAL OTHER <br /> SCHEDULING,MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIIVAL•ANY UNSCHEDULED LOAM ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL, ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST A 52 9;)11 <br />