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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill ' IY a '-}Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Lading Road 9899 5 Austin Road <br /> Pittsburg, CA 94565 Half Moon BaA 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 /> IS WASTE ACCEPTANCE NO. <br /> n <br /> MAILING ADDRESS <br /> 1 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTE T EQUIPMENT <br /> PHONE <br /> U GLOVES ❑GOGGLES U RESPIRATOR 0 HARD HAT <br /> U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE <br /> G,ENERATOR 6 CERTIFICATION I hereby certify that the above named material U rota hazardous <br /> waste as defined by 40 CFR Part 261 a title 22 of the Caldomua code ol regulations has been properly <br /> described classified and packaged and is m proper condition for transportation a`oordirtg to apphtabie <br /> regulations AND,If the waste is a tronbrient residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I Certify and warrant that the waste has been treated to 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 /> U DISPOSAL U SLUDGE <br /> Z)CONSTRUCTION Q WOOD <br /> Z11 DEBRIS 0 OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSEE NUMBER TRUCK NUMBER <br /> ADDRESS � t3 <br /> R <br /> CITY, ST <br /> PHONE tQ, CA 9582-- <br /> END U BOTTOM DUMP TRANSFER <br /> SIGNATU ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BEDTVAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 98 Yards <br /> 7 <br /> accepted and to the nest of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD (r0 BE COMPLETED 8Y LANDFILL) <br /> DISPOSE OTHER <br /> HEMARKS 0 SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OFAUTHORlZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> * Q ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO 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 N 52892 <br />