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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward ^^ <br /> Sanitary Landfill Sanitary Landfills Sariltary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road I 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Haff 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 /> I R33 VV_ <br /> CITY STATE,ZIP 93212 <br /> REQUIRED PERSONAL PRO TE T -EQUIPMENT <br /> c <br /> PHONE ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> 530 ASA-1;390 Q TY-VEK ❑OTHER <br /> CONTACT PERSOK <br /> l SPECIAL HANDLING PROCEDURES <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE iDATE <br /> * f <br /> GENERATOR S CERTIFICATION t hereby esitify that the above named material is not a hazardous <br /> wasta as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condrinon for transportation a vordmg to appl c*" <br /> regulations AND,H the waste Is a treatment residue of a previously restricted hazardous westo <br /> sublect to the Land Disposal Restrictions I Cellty and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with 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 /> �]DISPOSAL 0 SLUDGE <br /> J CONSTRUCTION O WOOD <br /> O DEBRIS ❑OTHER <br /> �J SPECIAL WASTE <br /> GENERATING FACILITY <br /> r <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRTwcking <br /> CITY, S <br /> c <br /> PHONE- <br /> END DUMP BOTTOM DUMP TRANSFER <br /> SIG NA ORIZED AGENT OR DRIVER DATEROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted 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 /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> * ❑ASH <br /> ❑SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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# 52890 <br />