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i <br /> ❑ Keller Canyon E] Ox Mountain ;` Newby Island [I Forward <br /> Sanitary Landfill Sanitary LandfilV-- 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)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> Mary Sanchez <br /> MAILING ADDRESS _ <br /> 1633 W Walnut Street # 3212 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton. CA 9520-1 O GLOVES ❑GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> SR9.S1CIq U TY-VEK Q OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFALITHORIZED AGENT/TITLE DATE <br /> G ESV TOR S CERTIFICATION i hereby oertLfy that the above named material is not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and w in proper condition for transportation a^cordrng to applicable <br /> reguiat ons AND,If the waste to a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrmbons I certify 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 Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL O SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> :)DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NNJUMBER TRUCK NUMBER <br /> IncADDRES <br /> F Rd <br /> CITY,STATE, GFeer <br /> PHON 1 GA 96828 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNA ORIZED AGENTjOR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 Wards <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 /> D SOIL <br /> REMARKS O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS _ <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> O ASH <br /> * U 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 WITH THE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST# 52885 <br />