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❑ Keller Canyon ❑ Ox Mountain �❑ Newby Island El Forward <br /> Sanitary Landfill Sanitary Landilll 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 WASTE ACCEPTANCE N0. <br /> Maw Ranrhpz <br /> MAILING ADDRESS <br /> A33 W Waln,it Street <br /> CITY, STATE,ZIP REQUIRED PERSONAL PRO TE T UIPMENT <br /> PHONE CA g5203 ❑GLOVES ❑GOGGLES U RESPIRATOR ❑HARD HAT <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GERATOR S CERTI FICATION I hereby certify that the above named material rs not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the Catrfomra code of regulations has been property <br /> descnbed elasarfied arr0 packaged and rs rrt proper condrbon for transportation a^cording to applicable <br /> regulations ANA H file waste Es a treatment residue of a prWously restricted hazardous waste <br /> subject to the Land Disposal Restncbons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ance ccordawith the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL ❑SLUDGE <br /> �]CONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, ST , <br /> GA <br /> 021121 <br /> PHON END DUW BOTTOM DUMP TRANSFER <br /> or ❑ ❑ <br /> SIGNATU ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been $ Yards <br /> accepted and to the best <br /> and accurate.of my knowledge the foregoing is DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS C1 SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER <br /> DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> D WOOD <br /> U ASH <br /> * <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO 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# 52886 <br />