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• anyon [] O-' Mountain <br /> I J Newby Isl id In I Forward <br /> tary Landfill CAary Landfill Sanitary idfill Landfill <br /> 1 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 /> GENERATOR --_ -- WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS — <br /> 2201 W. as ng oh St . A3z — -- 9200 <br /> 00 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton CA 95203 U GLOVES IJ GOGGLES U RESPIRATOR IYHARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON -- ---------- - - - <br /> Phil opP e <br /> -- -- —--- SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * Contractor 9/16/02 None <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> was <br /> Ia 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 proper condition for transportation n'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 /> 4o CFR Part 261. Forward Bandfill <br /> WASTETYPE: 9999 S. Austin Rd. <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION XIJ WOOD Manteca, <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1645 Cherokee Lane, Stockton, CA <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> m ore% CA 95`241-0357 <br /> ADDRESS — <br /> 77 <br /> P P. Box 357 <br /> CITY, STATE, ZIP <br /> T,ndi CA 95241 -0257 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIG NATO n g IPF AUTI IOR IZEDAIP ENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> I� I� I� ❑ <br /> CUBIC YARDS <br /> 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 /> Eft MARKS------ -- ---- -- U SOIL <br /> ---- -- U CONSTRUCTION <br /> -- ---- DEBRIS <br /> FACILITY TICKET N B R/__, _ _ _ _ __ rJ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATLIREOF,AO-THOPIZEDAG NT DATE — - - <br /> --- --------- U WOOD <br /> ASH <br /> 11 V E'GfAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE'DAY BEFORE. <br /> MANIFEST.#1 5 0 9 0 9 <br /> rr<n+cAATnn nriav <br />