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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island <br /> Sanitary Landfill Sanitary Landfill r Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road" 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,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 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE T R WASTE ACCEPTANCE NO. <br /> ti <br /> MAILIN%' DR S 48 — /031 <br /> CITY TATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ©GLOVES 0 GOGGLES Q RESPIRATOR O HARD HAT <br /> PHONE <br /> Q TY-VEK 0 OTHER <br /> CONTACT PE SON <br /> l %_11�jm I'VitwVtOc SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORI ED AGENT/TITLE DATE <br /> !• fes- Y <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> described classified and packaged and is to proper Condition for transportation a-corWng to applrcahla <br /> regulations AND If the waste Is a treatment residue of a p"Mousty restricted hasaedous waste <br /> sublecl to the Land Disposal Restrictans I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL Q SLUDGE <br /> O CONSTRUCTION 0 WOOD <br /> Ci DEBRIS ❑OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> ,5425 aci is Ave , Stockton, CA <br /> TRAIJ5PUjRNOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> _—__a TItIcklijW, Ile <br /> ADDR <br /> CITY, STATE,ZIP <br /> eA 95828 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 916 313 r-5864 Q_ Q 23 <br /> SIGN_AT F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 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 /> 0 SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NDN-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED AGENT DATE <br /> ❑WOOD <br /> 0 ASH <br /> * 0 SPECIAL OTHER <br /> SCHEDULNi3 musT Esc MADE PRIuRTO 5 uJ P M.T.E GaY PRICRTO EXPECTED XiRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AHRIvAL GNGOING DAILY DE.LIVERILS MUST BE SCKLDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 5,0689 <br />