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[J Keller Canyon ❑ Ox Mounta4ni , ❑ Newby Island p Forward <br /> Sanitary Landfill Sanitary Landfill 'o' 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 /> WON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Mary Sanchez WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 76 — <br /> CITY STATE,ZIP R32 9 <br /> EQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 0 GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> i)2vx*Threlfall SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * <br /> 4/1 <br /> o <br /> ,y3 <br /> GENE ATOR 5 CERTIFICATION I hereby certify that the above narned material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Mia 22 of the Caltfomia code of regulations has been property <br /> described classified and packaged and rs in proper condition for transportation a-cording to applicable <br /> regulations AND,if the waste is a treatment residue of a pravlousy restricted hazardous waste <br /> subject to the Land Disposal Restrictions I cerpty and warrant that the waste has been treated on RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined try <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS ❑OTHER <br /> �J SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRE 9'O spoop WF GFeek Red <br /> �0 <br /> CITY, ST , <br /> GA 95828 <br /> PHON&eFemeritei <br /> END P BOTTOM DUMP TRANSFER <br /> SIG NATU ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <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 <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 /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIOR TO 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# 52887 <br /> a2QQ7 <br />