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❑ Keller Canyon ❑ Ox Mountain Li NeWDY liallar C11- W' r'.VJY f,; <br /> Sanitary Landfill Sanitary Landfill Sihlt2lty L'aridfill <br /> $01 Bailey Road 42314 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Mooh Bay,CA 94019 Milpitas,GA 95035 ; MdMecb,CA 963M <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2640 Prone(20$)982;4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax'(400)262-2871 Fax(269)982-1009 <br /> NONHAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS16141AW Wgt1nLjjtStraPA it 321 <br /> -- <br /> CiTY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE UIPMENT <br /> O GLOVES U GOGGLES O RESPIRATOR 0 HARD HAT <br /> RHONE 530 66&5399 <br /> ❑TY VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dque Threlfall <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GE70R S CERTIFICATION I hereby oediy that the above named material Is not a hazardous <br /> w a as defined by 40 CFR Part 281 or Iltle 22 of the Camomia code of raguti ions has been Property <br /> described dassilied and packaged and ie In proper condition for vanspartation a-oordin0 to gWkablo <br /> regulations AND,H the waste is a treatment residue of it previously restricted hazardous waste <br /> aubJaet to the Land Disposal Reatricaons [art+ry <br /> and wartard that the weals has been vested in RECEIVING FACILITY <br /> ecoortlenee with the requirements of 40 CFR Part 268 and is no longer a hazardous wede as defined by <br /> 40 CFA Pari 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 4876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> sage r Cc ok Rd <br /> CITY, S ,ZIP <br /> PHONE GA 9682—SaGmmeoto, END DI.RdP BOTTOM DUMP TRANSFER <br /> SIGNAT A RIZED AGENT OR DRIVER DATE ROLL: F S FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS 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 /> A . ... 1C§p <br /> EMARKS U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> w <br /> ASBES'T'OS <br /> SIGNATUE OF AUTHORIZED AGENT DATE 0 WOOD <br /> r) <br /> / DASH <br /> ' O SPECIAL pTHFj <br /> F <br /> SCHEDULING MUk BE MA E PRIORTO 3.00,P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE,S00JEC'l <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEF,ORI , <br /> TRANSPORTER COPY MANIFEST 4 <br />