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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill' Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Say, 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 /> MAILING ADDRESS <br /> i 633 <br /> CITY ST IP REQUIRED PERSONAL PROTE UIPMENT <br /> PHON teelden GA 95203 O GLOVES ❑GOGGLES ❑RESPIRATOR (3 HARD HAT <br /> r <br /> CONO TY VEC ❑OTHER <br /> TAI; P <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNA ORIZEDAGENT/TITLE IDATE <br /> 4-112 <br /> GE3VERATOR S COMFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFA Pan 261 or title 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a eordr to frcabla <br /> regulations AND,N the waste Is a treatment residua of s previously rostrkted hazabousweato <br /> sublecl to the Lard Disposal Restrictions 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 /> O DISPOSAL ❑SLUDGE <br /> CONSTRUCTION O WOOD <br /> J DEBRIS 0 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 /> ADDRJ_S Son$ ir"CklmInc9 13 t/1 e 13 / <br /> an Z150-GrAnk Rd <br /> CITY, STA , <br /> GA <br /> PHON ENDDUMP BOTTOM DUMP TRANSFER <br /> Ur L3 <br /> SIGNA ORIZED AGENT OR DRfVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 7 ��-��' ' ❑ , a ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD CTO BE COMPLETED BY LANDFILL <br /> Is true and accurate ) <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> *• <br /> SIGNATURE OFAUTHORlZED AGENT DATE ASBESTOS <br /> O WOOD <br /> * ❑ASH <br /> ❑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 0 52888 <br />