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❑ Keller Canyon ❑ Ox Mountain v ❑ Newby Island ❑ Forward <br /> Sanitary Landfill fSinitary Lgndfill f 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)458-9899 Fax(650)726-9183 Fast(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING A DRESS ez <br /> I — <br /> -Wal Rut Street <br /> CITY STATE,Z P REQUIRED PERSONAL PROTECTIM MUIPMENT <br /> PHONECA.95203 ❑GLOVES 0 GOGGLES 0 RESPIRATOR ©HARD HAT <br /> ❑TY VEK (aOTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES - <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENE=R 5 CER n"CATION I hereby candy that ft above narned material Is not a hazardous <br /> wastd as defined by 40 CFR Pan 261 or title 22 of the Caldornra code of regulations has been pmpedy <br /> descr bed classified and packaged and Is in proper condition for transportation a Cording to appl"ble <br /> regulabons ANR if the waste is s treatment residue of a pravbusly restrieted hazardous waste <br /> subject to the Land Disposal Restrictions I co"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 /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> Z) DISPOSAL ❑SLUDGE <br /> :1 CONSTRUCTION ❑WOOD <br /> �)DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1376 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, ST <br /> PHONE CA 958228 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> r <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been IS 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 /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> IU WOOD <br /> IL <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL, ONGOING DAILY DELIVERIES MUST BE SCHEDULED WIT"THE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST# 52916 <br />