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❑ Keller Canyon ❑ Ox Mpuntain 4 i ❑ Newby Island ❑ Forward <br /> '1,. 4�4]r � <br /> Sanitary Landfill Sanitary Landfill ` " T Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San-Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Hal}Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9840 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 /> GENERAary anc ez WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS e # 3212 <br /> a n uee <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton CA 95203 O GLOVES O GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 530 668-5399 0 TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dave Threlfall <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE (D{ATT,E,�f� <br /> /fYJ�r' <br /> GENERA OR 5 CERTIFICATION I hereby certify that the above named material,Is not hazardous <br /> waste es defined by 40 CFR Part 261 or tilt 22 of the California code of regufab",=been property <br /> described classified and packaged and is m proper condrtlon for transportation a-oording to applicable <br /> regulations ANR if the waste is a Westmont residue of a previously restricted hazardous waste <br /> subject to the Land <br /> d Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> requirements of 40 CFFI Part 266 and Is no longer a hazardous waste as defined by <br /> at)CFR Part 261 1 <br /> WASTE TYPE <br /> C)DISPOSAL ❑SLUDGE r <br /> D CONSTRUCTION 0 WOOD <br /> �)DEBRIS 0 OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY ' <br /> 876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES. VEHICLE L#CENSE NUMBER TRUCK NUMBER <br /> ADDRESS 1 <br /> c o <br /> CITY, STATE, <br /> CA 95828 <br /> PHON END DU BOTTOM DUMP TRANSFER <br /> Er Ll Q <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> y_z 3 -s <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 /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-PRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> O ASH <br /> * O SPECIAL OTHER <br /> r <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL t 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 5 2 9 l - <br />