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❑ Keller Canyon ❑ Ox Mounlairr,, r ❑ Newby Island ❑ Forward <br /> Sanitary Landfill SanitaryF Landfill Sanitary Landfill Landfill <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Say,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 /> rtary Sanchez <br /> MAILING ADDRESS _ <br /> `^ <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> PHONE <br /> ❑GLOVES 0 GOGGLES ©RESPIRATOR U HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> -):;ivA Threlfall SPECIAL_HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT f TITLE DATE <br /> G£faERA'rOR S r-r:FMFICA-nON I hereby certdy that the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the CaRomra code of regulations has been properly <br /> described ctassrfed and packaged and is in proper oonddion for transportation a cording to applicable <br /> regulations ANDt If the waste to a treatment residue of a prairlousfy raetrialad tweandous waste <br /> subject to the land Disposal Restnctrons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wdh tie requ sments of 40 CFR Part 268 and Is no longer a razardous waste as defined by <br /> 40 CFA Pad 261 <br /> WASTE TYPE <br /> D DISPOSAL Q SLUDGE <br /> Z)CONSTRUCTION ❑WOOD <br /> *DEBRIS 0 OTHER <br /> O SPECIAL WASTE - — - <br /> GENERATING FACILITY <br /> -815 Country Club Blvd, Stockton, CA 98203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley 8r Sons TruCking. Inc. <br /> ADDRESS <br /> R <br /> CITY, STATE,ZIP <br /> Sae-rnwentoPHONE END DU BOTTOM DUMP TRANSFER <br /> SJGNATUR F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER- <br /> 0 SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> h NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> a ASH <br /> * D SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.010 PM THE DAY PRIOR TO EXPECTED ARRIVAL.a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> I TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> - - TOR COPY MANIFEST! C ell©a 4 <br />