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A e e� ny�o xl"Vl l ;�1 4 W -I ' Wnffde L�ndfill � ry� oF, -s_q �adfi� K ., � , r y. ? ti,, a r^ 4 <br /> Bails Road;- _ ,,12310 San�Aateo,Road�_� Y w _ -1601�`Dixon Lar�dng Fio' d"' fi 99 S.'Austl ' <br /> "r z a Pdtgbuy ,CA 94565 � Half Moon Bay;CA 94019 `- �" �r M1 odas,CA95035;'z r ';;` :`- :_MBirlteca% <br /> Phone(925)458-9800 Phone(650)726-1819 +' Phone(408)`J45-2800`"'= ''` `S Phone(209)9,9Z-4298 <br /> ' Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 } Fax(209)982-11)09,!�'; <br /> _ TM <br /> ' NOK-HAZARDOUS WASTE MANIFEST <br /> r- GENERATOR <br /> l' r fs VI�ASTE ACCEPTANCE N0. <br /> MAILING.ADDRESS- t _ »;4- ,, _• r _ ` : , <br /> bO <br /> X 14046 r <br /> CITY,STATE,ZIP µ REQUIRED PERSONAL_PROTECTIVE i MENT_= <br /> Sacramento, <br /> PHONE ❑GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> U TY--VEK ❑OTHER <br /> CONTACT PERSON <br /> Geo(g—e—Uonverse SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> GENERATAR'S.ctRTiFicATtoN I hereby comfy that the above named material is not a hazardous w <br /> waste as defied by 40 CFR Part 261 or title 22 of the Caidomerty <br /> ia code of regulatrom has boon prop <br /> descnbed clasm6ed and packaged and rs in proper condstron for ber4portatwn a-oordu,g to applicable <br /> regulations,AN[%H the waste 1s a treatment residue of a Previously restricted hazardous waste <br /> e�eato the a w�Drspo.al Res'ncwts I ce"and warrant thal the waste has been treated rn RECEIVING FACILITY <br /> ragwrements of 40 CFR Part 268 and is no longer a hazardous waste as defrmd by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION C3 WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 6425 Pacific Ave . Stockton, CA <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I n tic l , ll' <br /> ADDRESS <br /> 00915 Elder ,fee 0 <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> I u ,-n 'a � ❑ r <br /> SIGNAffU OF 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 /0 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 /> REMARKS ❑SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER ` DEBRIS <br /> ❑NON-FRIABLE <br /> % ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> �LM1IpOD <br /> ASH <br /> t O SPECIAL OTHER <br /> i • <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P.M THE DAY PRIORTO 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 /> TRANSPORTER COPY MANIFEST# 5 D U 8 8 <br />