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r� -a a u c�nounia� u <br /> a r~ Landfi I San tary�Landfill s a -011 11 d ill <br /> s „- `"i-'.�r "'E34n r' <br /> b1 r alley(load e�. 12310 San Mateo kload,.;°�1r 16�D�eon, Ing R - , , A r Dari <br /> PltfSbdrC'CA 94565`W , ' .r3 Halt Moon il(iitas, <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408}945-2840 =_s' -" �F>one'(209)9$2�-4298 <br /> a Fax(925)458-9891 Fax(650)726-9183 fax(408)262-2871 FaK(209)982=1009 <br /> NON-HAZARDOUS WASTE MANIFESTGENER.ATOR <br /> F_ f .:L,,.;T WASTE ACCEPTANQg NO."` <br /> MAIL! R �_ + •• - , f� _ _ ,`; <br /> a~T ! ~T <br /> - +'+ <br /> CITY, TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT ' <br /> ' ❑GLOVES ❑GOGGLES O RESPIRATOR - O HARD HAT <br /> PHONE . - <br /> ❑TY-VEK ❑OTHER <br /> ICONT,4CT'PE $ON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE , <br /> 71 <br /> sr <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by Q CFR Part 261 or true 22 of Lha Caldonua code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a�cor�Eng to applicable <br /> regulatwns AND It the waste Is a treatmant residua of a previously restricted hazardous waste <br /> subject to the Land pksposal ResInCtrons I comfy arta warrant that the waste has been treated in RECEIVING FACILITY <br /> accordanoe with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> D DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 05420 Parrhc Ave, Stockton, <br /> IRAN ,O 3-1: IleNOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> S (o9S <br /> ADDRESS T <br /> Cme� Rd <br /> CITY STATE, ZIP _ <br /> .1n 1 J f- <br /> T <br /> PHONE " END DUMP BOTTOM DUMP - TRANSFER <br /> SIGNATURtQF AUTHORIZED AGENT OR DENVER DATE ROLL-OFF(S) 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 (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGtEN ,DATE _ <br /> ❑WOOD <br /> r <br /> O ❑ ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL+ANY UNSCHEDULED LOADS ARE SUBJEC <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTEP COPY MANIFEST a 51 00' 8 9 <br />