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❑ Keller Canyon ❑ Ox Mountain �] Newby Island ❑ Forward <br /> Sanitary Landfill Sanitaryandfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San M06 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 /> Mary Sanchez WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 1633 W Walnut Street 3 �1 <br /> CITY, STATE,ZIP R- Stockton, CA 95203 EQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> ' 0 TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE Dt,ATE <br /> G ENERATOR S CERTIFICATION 1 hereby certify that the above named matena;is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulafto has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND.If the waste Ina treatment residue of a previously restrWM hazardous waste <br /> subject 10 the Land Disposal Restnctions I certify 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 GFA Part 261 <br /> WASTE TYPE <br /> :7 DISPOSAL U SLUDGE <br /> :1 CONSTRUCTION 0 WOOD <br /> ❑DESRIS ❑OTHER <br /> ZI SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Ccurtry Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VENC LIC NSE NUMBE-kinm Int- R TRUCK NUMBER <br /> ADDRESSr r 1 G <br /> CITY S 5110_ <br /> PHON E MP BOTTOM DUMP TRANSFER <br /> SIGNA F ORIZED AGENT OR DRIVER DATE ROLL-0FF S FLAT-BED VANDRUMS <br /> i <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REtYZARKS 0 SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DESRIS <br /> NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> * ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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# 52891 <br />