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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ElForward <br /> Sanitary Landfill y SaAltaeV Landfill r '� Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 Sart 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 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 A DRESS _ <br /> 113"43 vvWalnut stmet <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> .PHO4 CA ❑GLOVES 0 GOGGLES ❑RESPIRATOR Q HARD HAT <br /> � Y O TVEK ❑OTHER <br /> CONTAC <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFA T ORIZEDAGENT/TITLE DATE <br /> J <br /> GENE TORS CERTIFICATION I hereby cerbty that the above named matena€is not a hazardaus <br /> wgw4 as defined by 40 CFR Part 261 or title 22 of the Caldomia code of regulations has been property <br /> descnbed classified and packaged and is m proper condition for transportation a-cording to applicable <br /> regulations AND,If the waste is a treatment residue of a previously restricted hazardous watdo <br /> subject to the Land Disposal Restrictions I comfy and warrant that ft waste has been treated m RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and Is no longer a hazardous waste as defined by <br /> 40 GFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL (3 SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBERI TRUCK NUMBER <br /> ADDRE 0loySOASInc C) <br /> "Pip 908F QF9ek Rd <br /> CITY, ST <br /> GA 959219 <br /> PWON END DU—N107 BOTTOM DUMP TRANSFER <br /> SIGNATU ORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> Q SOIL <br /> REMARKS <br /> ©CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> C]WOOD <br /> U ASH <br /> * 13 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 k 52920 <br />