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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 0 Forward <br /> Sanitary Landfill ' iitary Landfill Sanitary ndfill Landfill <br /> 901 Bailey Road 'i__10 San Mateo Road 1601 Dixon _.,ding 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> ST Services <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> J uoc .On, UA ❑GLOVES Q GOGGLES Q RESPIRATOR SHARD HAT <br /> PHONE <br /> (209)943-;662 ❑TY-VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Mike Qi <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Contractor 3/13/01j None <br /> 'GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged.and is in droner condition for transoortation a cording to applicable , <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,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. Forward Ll a.Y.1dfoi 11 <br /> WASTE TYPE: <br /> `b DISPOSAL Q SLUDGE 9999 S . Austin Rd <br /> ❑CONSTRUCTION ❑WOOD Manteca, Cas 95336 <br /> Q DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 3:505 Pavy Dr. , Srockton, CA <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> JiT 1norp-a .'11 , ii 3. <br /> ADDRESS <br /> .P.O. OX <br /> CITY, STATE,ZIP <br /> Lodi , CA 95242-0357 f>. <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE 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 - <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 /> Q SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZEDAGENTr,. DATE - l <br /> Q WOOD <br /> I �1 <br /> A Q ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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 /> GENERATOR COP`! MANIFEST# <br />