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❑ Keller Canyon ❑ Ox MountaI6 ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfilt = ° Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road ' 1601 Dixon Lan Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95Q�~ ' Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650) 726-1819 Phone(448)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 anc ez WASTE ACCEPTANCE NO, <br /> MAILING ADDRESS <br /> o alnut Street — # 3212 <br /> CITY, STATE,ZIP REQUIRE©PERSONAL PROTECTIVE EQUIPMENT <br /> HONE Stockton CA 9523 a GLOVES O GOGGLES Q RESPIRATOR ©HARD HAT <br /> P <br /> 530 668-5399 O TY-VEK ❑OTHER e- <br /> CONTACT PERSON <br /> Dave Threlfall SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE LA;TE <br /> GENERATOR S CERTIFICATION I hereby certify that the apove named matenal is nota hazardous <br /> waste as dafined by 40 CFR Part 261 or title 22 of the Califomia code of regulations hea bean property <br /> described classified and packaged aril Is in proper Condition for transportation a-cording to appficabie <br /> regulations AND ff the waste Is a treatment residue of a previously restricted hazardous wasLo <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> J DISPOSAL Q SLUDGE <br /> Z)CONSTRUCTION Q WOOD <br /> O DEBRIS O OTHER <br /> ::I SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER STRUCK NUMBER <br /> ADDRESS <br /> CITARCIFt =Wer Creek Rd. <br /> Y, STATE,zip <br /> GA 95 <br /> PHON 28 END U BOTTOM DUMP TRANSFER <br /> SIGNATM9 MORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ Q <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 /> REMARKS 0 SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ©NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> ❑ASH <br /> Q 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# <br /> 1 <br /> 52895 <br />