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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill = 4,-� - �-!Sttnitary Landfill Landfill <br /> 901 Bailey Road 12310 San MAteo Road' 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Halt 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 A DRESS <br /> I W3 93212 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECT EQUIPMENT <br /> PHONE CA ❑GLOVES ©GOGGLES D RESPIRATOR U HARD HAT <br /> ❑TY VEK U OTHER <br /> CONTAG <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNAT ORIZEDAGENT/TITLE DATE <br /> 7 <br /> GENERATOR S CERTIFICATION I hereby certify that the above named materiel is not a hazardous <br /> waste as defined by 40 CFR Part 261 or boo 22 of the California coda of regulations has been property <br /> described classified and packaged and W in proper condition for transportatlon&-cording to applicable <br /> regulations AND,it the waste is a wastinent residue of a previously restricted hazardous waste <br /> subject to the land Disposal Rosindans 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 CFR Part 261 <br /> WASTE TYPE <br /> 7 DISPOSAL ❑SLUDGE <br /> :1 CONSTRUCTION! ❑WOOD <br /> J DEBRIS ❑OTHER <br /> 7 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDR Giteek Rd <br /> CITY, ST <br /> GA 05829 <br /> PHONE-- END DUMP BOTTOM DUMP TRANSFER <br /> SIGNA ARMOR[ZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> Ll <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been g yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED 9Y LANDFILL <br /> is true and accurate. ) <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZEDAGENT DATE ASBESTOS <br /> ❑WOOD <br /> ❑ASH <br /> EEL— U 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# 52894 <br />