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nyon U Ux Mountain <br /> ry Landfill S 'ar Landfill �--� Newby Island KJ Forward <br /> Bails Road y Sanitary dfill Landfill <br /> Bailey 12„,,,San Mateo Road 1601 Dixon Lar ruin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 950358 9999 S.Austin Road <br /> Phone(925)458-9800 Phone(650) 726-1819 Phone 408 945 2800 Manteca, CA 95336 <br /> Fax(925)458-9891 Fax 650 726 9183 ( ) Phone(209)982-4298 <br /> ( ) Fax (408) 262-2871 Fax (209)982-1009 <br /> NONHAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> CCT — WASTE ACCEPTANCE N0. <br /> iDat <br /> Il <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP 11 ' <br /> -- __ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ----- ❑Ahi <br /> GLOVES U GOGGLES U RESPIRATOR HARD HAT <br /> U TY-VEK U OTHER <br /> CONTACT PERSON -- -- ----- <br /> _ __ SPECIAL HANDLING PROCEDURES: <br /> Co-p�_1 e ----- --- <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * Contractor /16/02 No1e <br /> GENERATOR'S CERTIFICATION:I hereby cedify that the above named material is not a hazardous t, <br /> waste as defined by 40 CFR Pad 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 waste has been treated In <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: — Forward Landfill <br /> U DISPOSAL U SLUDGE 9999 S. Austin Rd. <br /> UCONSTRUCTION WOOD �ariteCa� CA 95336 <br /> �j <br /> U DEBRIS OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY r <br /> 1645 Chef6kee Rd. , Stockton, CA <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBERJin IhorpA oil , Tnr,, _ <br /> ADDRESS <br /> P.,0,f, Box 357 --- . <br /> CITY, STATE,ZIP _ <br /> O , J <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 0 L) <br /> SIGNATURE 9k AUTHORIZED AGEN R DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> � (J* L °I I a <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 /> EMARKS ------ -------- ----- --- U SOIL <br /> — ---- ---------------- <br /> —. - -- --- - — - - - -- — ------ - U CONSTRUCTION <br /> FACILITY TICKET NUMBER — - DEBRIS <br /> -- ----------- U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT ______ DATEA RESTOS <br /> -------------- -- -— WOOD <br /> U ASH <br /> '1' o f <br /> 167 U SPECIAL OTHER <br /> CHEDULING WST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADSARE SUBJECT <br /> O RI FUGAL UPON ARRIVAL, ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> C ( FWAAT.r% A COPY MANIFEST#150910 <br />