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❑ Keller Canyon ❑ Ox Moun ❑ Newby Island ❑ Forward T <br /> Sanitary Landfill Sanitary Landfill 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)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR__ -Mary Sanchez WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP R93212 <br /> EQUIRED PERSONAL PRATE T QUIPMENT <br /> c <br /> PHONE t]GLOVES D GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> �'4 sea 5199 ❑TY VEK (3OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * F --IC_ <br /> G Ejil TOR S CERTIFICATION I hereby cartAy that the above named material is not a hazardous <br /> wdste as defined by 40 CFR Part 261 or btle 22 of aha Callfom=a 00de of regulabons has been properly <br /> described classified and packaged end a m proper condition for transportation a-eordng to applkxbla <br /> regulations AND <br /> If <br /> the waste Is a treatment residue of a prwbusly restAeted hazardous waste <br /> subject 10 the Land Disposal Restrictions I certify and warrant that the waste has been treated inRECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> Z)DEBRIS O OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1878 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSnipyRnnqIniCking <br /> " <br /> p;Q08k Rid <br /> CITY, STATE, 1 <br /> PHONE GA @6829 <br /> END DUMP BOTTOM DUMP TRANSFER <br /> Zr Q El <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> `1 z <br /> CUBIC YARDS <br /> I hereby certify that the above reamed 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 /> FIEMARKS D SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZEDAGENT DATE ASBESTOS <br /> •WOOD - <br /> * ©ASH <br /> D SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P WTHE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH ;rHE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST N 52883 <br />