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❑ Keller Canyon C] Ox Mountain a E] Newby Newby Island ❑ <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill LandfillRoad <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road Manteca ustin CA 95336 <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 298 <br /> 982-4 <br /> Phone(209) <br /> Phone(925)458-9800 Phone (650)726-1819 Phone(408)945-2800 Fax{209)9)982-49 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 1C", n tl <br /> MAILING ADDRESS 1303 <br /> 1 -1 oux i1:1104 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CITY STATE, ZIP <br /> acramen a ❑GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE 0 TY-VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> y r j <br /> GENERATOR S CERTIFICATION I hereby COntY that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tale 22 of the California Coda of regulations has been Perry <br /> described classified and packaged and is in Proper Condition For transportation a-oordung to apphcabfe <br /> regulations AND It the waste Is a tmatment residue of a previouaty restrioted hazardous waste RECEIVING FACILITY <br /> subject to the Land Disposal Restrictions I Certify and warrant that the waste has been treated to <br /> accordance with the requirements of 40 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Z)DISPOSAL 0 SLUDGE <br /> Zi CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 OTHER <br /> *SPECIAL WASTE <br /> GENERATING FACILITY <br /> 342 Pacific Ave , Stockton, CA <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 9-C-191�r <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> END DUMP BOTTOM DUMP TRANSFER <br /> PHONE <br /> - o ❑ <br /> SIGN A OF AUTHORIZED AGENT OR DRIVER DATE ROLL�FF(S FLAT-BED V� DRQ S <br /> f <br /> 29,01 <br /> CUBIC YARDS <br /> /0 Yards <br /> I hereby certify that the above named material has been <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 /> O SOIL <br /> REMARKS U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM.THE DAY PRIORTO EXPECTED ARRIVAL ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES <br /> EN RATOMUST E SCHEDULED WITH THE OPYMLAAHEST L <br /> DTH 50688 A RE. <br />