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-Keller non Lj Ux Il ountaln a evyp s f Q t_1 ,e ; <br /> Sanitary Landfill Sdnita6f Lh6dflll f Sarii al 'i:��r�ic�1,'- `i L ' Fd.� <br /> C x f L=' ttdfllT <br /> 901 Bailey Road ._ 12310 San Majeo Road 1601 Dixop L4Lndkng Load 9999 S Austin Road <br /> Pittsburg,CA 94565 H41f Moon BAy, CA 04019MiE to ;'� 5b3 , , MantecaKQA 953 6 <br /> Phone(925)458-9800 Phone(650)7gfj-1819 Phopa(�#QB)4 5-2Qb0 0t14[1g(eo§ 989-4298 <br /> Fax(925)458-9891 Fax(650)726=9183 fax(408)262-2871 ' Fax(2&}92-1009 <br /> s <br /> NON-HAKARDOUS WASTE MANIFEST <br /> •4 a F i,�,JY� <br /> GENERATOR WASTE�ACCEPTANCE NO. <br /> Mary Sancha7 <br /> MAILING ADDRESS <br /> —1833-w-wainfit AMU <br /> ,.. <br /> CITY,SPATE,ZIP REWIRED PERSO AL PROTE TI UIPMENT <br /> St-6+-n CA 95203 ❑GLOVES ❑GOGGLES O RESPIRATOR U HARD HAT <br /> PHONE--- ----- <br /> EN <br /> HONE <br /> ❑TY VEK 'a OTHER <br /> 530 668--6390 <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ua <br /> G ERATOA'S CERTIFICATION I�pr�by oertlty Ilial tho above reamed matertal b not a harardara <br /> teas dettrwd by 40 CFR Part,26f or hde 22 at the Ce�lonra ood9 W roputaUom,line bean P��Y <br /> described,deaalNed and packaged and b In Proper bor�lieoe!for trareporlatlan a�or�ag to appllrabb <br /> regulstkxre,ANq K the waste 1�a tnarsDnent reeldue of a prerbwy matrlcted hazaldoaa weate <br /> aubJect to the land alsposal Restrk�lwts 1 cart[ty and warrent mat ma waste has[seen treated In RECEIVING FACILITY <br /> accordance wlm the requtrarnanta d 40 CFA Part 288 and k no lager a hazardous weals as dented M -- <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd,,Stockton, CA 95203 <br /> TRANSPORTER NOTES' I VEHICLE LICENSE NUMBI4R TRUCK NUMBER <br /> ADDRE8896 EMId F Crook Rd <br /> � <br /> CITY, STATE,ZIP <br /> PHONE SaoramentG, CA 951329 END DU BOTTOM DUMP TRANSFER <br /> SIGNAAWMAMRIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BCD VAN DRUMS <br /> ❑ Q ❑ ❑ <br /> CUBIC YARD$ <br /> herebycert[ that the above named material has been- - <br /> certify 1$ 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 /> DISROSE OTHER <br /> �r <br /> � 1= AR $ ti - -_ _ ., - f i ..,. +,..1 t1xSat•h�r rah-s7�"tWt r' ^f^-,. �,a'tlaf,s <br /> Q CONSTRUCTION <br /> DE RIS r. <br /> FACILITY TICKET NUMBER U NON•FR ABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZEDAGENT DATE - 6 WOAD <br /> IU A&' <br /> DSP Ci 4 0 ER, <br /> SCHEDULING MUST BEADE P lORTO3 00 PM THE DAY PRIORTO EXPECTED ARRNAIL-AMY UN�SCHEOULED LOADS AAE SUBJECT <br /> TO REFUSAL UPON AR L ONGOING DAILY DELIVERIES MUST BE SCHEDULED Wrrtl THE LANDFILL THE DAY BEFORE. <br /> TRANSPORTER CQPY MANIFESt# Y�+'1► <br />