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>Renrer canyon, U Ux 1No(lnt4iin i ❑ Newby IgrALnd '[] FOrW4 dr- <br /> Sanifbi'Y Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601,Dlxon i-nding Road 9$99-5 Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,t;A 940i 9 Milpitas,CA 9�`b35 Mat!*� CA 9 336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone t2o)98�-4298 <br /> Fax(925)458-9891 Fax(650) 726.9183 Fax(408)262-2871 Fax(209)982-1009 <br /> a = , <br /> +ANON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE N0. <br /> Mary Sanchez <br /> MAILING ADDRESS _ <br /> 1633 W Walnut Street # 821 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Stockto CA 95203 ❑GLOVES U GOGGLES ❑RESPIRATOR U HARD HAT <br /> 53Q 015399 Q TY VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFA HORIZEDAGENT/TITLE DATE <br /> GEN TOR S CERTIF7CA'n I hereby candy that the above named material b not a hazardous <br /> wasCe as defined byA4 CFR Part 261 or dile 22 of the COomin dodo of regulations,Me been property <br /> described,ctassifled end packaged,end Is In proper candalon for transportation a-vording to appdcabla <br /> regulation ANO,N the waste Is a treebnent residue of a previously restricted hazardous waste RECEIVING FACILITY <br /> subject to the Land Disposal Restrictions.I oerdfy and warrard that the wait-has been treated In <br /> accordance with the reWmranta of 40 CFR Pen 268 and is no larger a hazardous waste an defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> •DEBRIS O OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> IA75 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TUCK NUMBER <br /> Mgnia4j 0- <br /> ADDRESS -,:)6 ?JQJQQA Rep Greek PA <br /> 6 <br /> CITY,STATE, <br /> PHONE SaccamentoCA 28 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATORA ORIZEDAGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> Ar <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 /> i OSOIL <br /> EMARKS <br /> U CONSTRUCTION a <br /> FACILITY TICKET UM DEBRIS R ❑NON-FRIABLE <br /> ASBESTOS <br /> S NATUREDFAUTHORIZEIRLAGENT PATE <br /> ❑WOOD <br /> O CIAL OTHER <br /> SCHEDWI G MUST BE MADE PRIORTO 3:00 RM THE DAY PRIORM 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 /> __-_ __TAANSPORTERCOPY <br />