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[:D Keller Canyon _❑ Ox,Mountal � , El Newby Island �- E] Forward <br /> Sanitary Landfill Sanitary L��nc'�fil1 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 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 /> PAacy Sanchez <br /> MAILING ADDRESS _ <br /> 1 8a3�& Walnut Street A 321 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> P— Stockton- CA 95203 <br /> HONE O GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> 530 668-5399 ❑TY VEIL O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITL DATE <br /> GEN BATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or bile 22 of the Caldomia code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-carding to applicable <br /> regulations AND,11 the waste is a treatment residue of a previously reshietod hazardous waste <br /> subject to the Land Disposal Restrictions t certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> D DISPOSAL 0 SLUDGE <br /> O CONSTRUCTION ❑WOOD �! <br /> ZI DEBRIS ❑OTHER sf <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1$7'6 Country Club Blvd, Stockton, CA 95205 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley 8 Sons 1 <br /> ADDRESS <br /> Rsch3 piri r Crelpk Rd <br /> CITY, STATE,ZIP <br /> PHONE END DVMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * X11 1. ? ❑ ❑ ❑ ❑ <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 O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> * O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M.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# 5288 <br />