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❑ Keller Canyon ❑ Ox Mountain Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary L4ndfill Err . , 'dSanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Ma eo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Ba ,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 r <br /> - NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Sanchez <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONEStor_kham_f'_A 952Q3 U GLOVES ❑GOGGLES Q RESPIRATOR ❑HARD HAT <br /> 53n PAR-s-AcA ❑TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE J, <br /> IGFNE9TOR S CERTIFICATIONm <br /> I hereby aeddy that the above named matodal is not a hazardous <br /> waste as defined by 40 CFR Pad 261 or title 22 o1 the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cordutg to applicable <br /> regulations AND,H the waste is a treatment raaldue of a previously restricted twrardous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> �J CONSTRUCTION O WOOD <br /> D DEBRIS 0 OTHER <br /> ZI SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> lang, Inc <br /> 90DREfSanIey'JL �$ 7 <br /> CITY, S , 1 <br /> PHON eai;FasnentoGA 95922 END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGMA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> r ' l - ii/ ❑ ❑ ❑ ❑ <br /> r �/ <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 /> U SOIL <br /> FEMARICS <br /> ©CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED AGENT DATE <br /> C!WOOD <br /> O ASH <br /> * ❑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# 52896 <br />