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Her'Can'Canyon y [] C'-- Mountain [J Newby Is'-ndU Forward <br /> ltary Landfill %c- itary Landfill Sanitary idfill Landfill <br /> 1'Balley 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 /> [GEtNERATOR — WASTE ACCEPTANCE NO. <br /> NG ADDRESS <br /> 0 W. Was n ton �3�— 920000 <br /> Y, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton, CA 95203 U GLOVES U GOGGLES U RESPIRATOR 13 HARD HAT <br /> PHONE <br /> r2 9)400-6927 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Copple - - - SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * Contractor /16/02 None <br /> GENERATOR'S CERTIFICATION:I hereby certify that the abovh 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 property <br /> described,classified and packaged,and Is in proper condition for transportation 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 wasle 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 Ped 261. Forward Landfill <br /> WASTE TYPE: <br /> - 0999 S. Austin <br /> •DISPOSAL U SLUDGE <br /> U CONSTRUCTION XWOOD Manteca., CA 90336 <br /> U DEBRIS U OTHER - <br /> U SPECIAL WASTE _ <br /> GENERATING PACILITY <br /> 1645 Cherokee Ln. , Stockton, CA <br /> TRANSPORTER _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim Thorpe _Oil, Inc. _ ---- <br /> ADDRESS <br /> P.O. Box 357 <br /> CITY, STATE,ZIP <br /> PH 1 CA � <br /> END DUMP BOTTOM DUMP TRANSFER <br /> ❑ - U <br /> SIGNATU F AUTHORIZED ENT OR DRIVER DATE, ROLL-OFFS FLAT-BED VAN DRUMS <br /> Ll <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 /> ----------- --- ------- - ------- - U SOIL <br /> EMARKS <br /> - -- -- -- --- U CONSTRUCTION <br /> -- ------------- ____ <br /> FACILITY TICKET NUMBER DEBRIS U NON-FRIABLE <br /> _ <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS _-- <br /> - -- --- — -- ---- t XV OOD <br /> U ASH <br /> 6/�-- O SPECIAL OTHER <br /> �I iti:4 <br /> SCHEDULING MUT BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL ANY,UNSCHEDUL&UTADS ARE SUBJECT <br /> TO 11lFUSAL UPO ARRIVAL. ONGOING DAILY DELIVERIES`:MUST BESCHEDULED WITH THE'LANDFILGTHE'DAY BEFORE. <br /> MANIFEST k'1 5 O 9 O Q <br /> AFWFIATnR COPY <br />