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❑ Keller Canyon ❑ Ox Mountain ❑, Newby Island ^~❑ Forward <br /> Sanitary Landfill Sanitary Lancffli M"'4 ` �'A Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austen Road <br /> Pittsburg,CA 94565 Halt 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 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTE_PtocT UfPMENT <br /> PHONE 'ktgn0 GLOVES O GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> ❑TY VEK 0 OTHER <br /> CONTAC P S <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE <br /> ;17 <br /> GE 0"CERTIFICATION I trereby cartry that the above named material is not a hazardous <br /> waste as defined by 40 CFR part 263 or title 22 of the California code of regulations has boon property <br /> described elassrfied and pa(kaged and is in proper oorxfition for transportation&-cording to applicable <br /> regulations ANA If the waste Is a treatment residue of a previously restricted hazardous wast& <br /> subject to the land Disposal Restrrclio s I certify and warrent that the waste has been treated rn <br /> accordance wrth the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 GFR Pal 261 <br /> WASTE TYPE <br /> D DISPOSAL 0 SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> 0 DEBRIS 0 OTHER <br /> ZI SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRE a �� � <br /> CITY, ST <br /> PHON <br /> �DP BOTTOM DUMP TRANSFER <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS <br /> FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing $ Yards <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OFAUTHORIZEDAGENTDATE ASBESTOS <br /> O WOOD <br /> * ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 RM 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# 52884 <br />