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❑ Kelier, a�ypn ❑ Ox Mountain U ^Vw° �5 I Fanitary Landfill Sanitary L�Indi�ill S�rif ' t� ii� Lantlflil ' <br /> 901 Bailey Road L 12310 Sqn JAii9.9 Road 1601 Dui on Candido Road 9999 S Austin Road <br /> �,Plttsburg,CA 94565 Half Udoh Bay,CA 94619 Mllpltals,CAts�ob - 141e�nt a,CA,9S33B <br /> Phone (925)458-9800 Phone(650)726-1819 Phone(408)94�-2800 Phone(209)982=4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)96Z-2$71 ' Fax(909)982-1009 <br /> NON-HAZARDOUS WASTE MANiFeq <br /> += GENERATOR WASTErACCEPTANCE,NO. <br /> Mary Sanchez <br /> MAILING ADDRESS <br /> 1653 W Walnut Street ' <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton CA 95203 ❑GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> 530 66&53 ©TY VEK Ci OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dave Threlfali <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> Dt <br /> 7Xyf e 3 <br /> GENE F'S CERTIFICATION I hereby cartlly that the above marled material Is rbt a hazardous <br /> W as deflned by 40 CFR Part 201 or tide 22 of ft Cafforria 009 Of <br /> MWaghas been propedy <br /> d scnbed,daaStfi d and pp&kaged ane IS M prgW CMdKjotl forkahsvd[adorJ a"00fdlf1e m apoicabla <br /> regulations AND,it tfar waste Is a vaeurrent residua of a pryviousty resu$&Ad hazardous waste <br /> subject to the Land 0*00al Feat1UI0r s,I WY and warrarri that fhe waste has beers treaW In RECEIVING FACILITY <br /> accordance with bre regrdremsrtts of 40 CFR Part 260 and Is no broar a hazardous waste as defined by <br /> 40 CFA Part 261 a F <br /> WASTE TYPE <br /> •DISPOSAL L]SLUDGE ;A'� � r*f <br /> ❑CONSTRUCTION 1 ❑WOOD r <br /> ❑DEBRIS U OTHER <br /> a SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1870 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES. I VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley 8r SaIS Trucking, Inc Flo/.<-/ �,- <br /> ADDRESS <br /> 8896 Elder Creek Rd <br /> CITY,STATE,ZIP <br /> Sacramento C M28 PHONE END DUOK BOTTOM DUMP TRANSFER <br /> 5I ATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> r <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 (r0 BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> ' DISPOSE OTHER <br /> SAIL <br /> t EMA K5 4 .❑CONSTRUCTION <br /> UEBRTS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> 4K ASBESTOS <br /> SIGNATURE OFAU AGENT DATE a WOOD <br /> 0 ASH' ti . <br /> * ©SPECIALOTHFR <br /> ri <br /> SCHEDULING MUST SkMADePRIORTO 3.00 P.M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUB.IECT <br /> TO REFUSAL UPON ARRIVAL.. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TWMpORYER COPY MANIFEST# 52881 <br />