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ler Canyon ❑ Ox Mountain L] Newby Island KI Forward <br /> anitary Landfill St ary Landfill Sanitary L Hill Landfill <br /> 61 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 /> "FORGENERATOR WASTE ACCEPTANCE NO. <br /> 2201 W Washington, St. #12 920000 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton, 95203----- ---------- -- U GLOVES U GOGGLES U RFSPin/ TOR XJ HARD HAT- <br /> PHONE <br /> 029)466-692 7 ❑TY-VEK U OTHER <br /> CONTACT PERSON — <br /> Ph o le -- SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * Contractor 9516/02 None <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above rimmed maledel Is not a hazardous <br /> waste as doined by 40 CFR Part 281 or title 22 of the California code of regulations,hes been properly <br /> described,classifled and packaged,and Is in proper condition for transportation a cording to applicable <br /> regulation";AND,If the waste Is a treatment residue of a previously restricted hazardous waste TY <br /> subject to Tho Land Disposal Restrictions,1 codify and warrant Ihat the wase"has born Irestsrl In RECEIVING FACILI <br /> ecoordence with the requirements of 40 CFR Part 288 and Is no longer a hazardous waste as defined by <br /> 40 CFR Pert 281. ------------------------------------------ ;. .I <br /> WASTE TYPE: Forward Landfill <br /> 9999 S. Austin Rd. <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION XJ WOOD Manteca, J <br /> 336 <br /> O DEBRIS U OTHF-R <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1645 Cherokee Lane, Stockton, CA 95 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim Thorpe -oil , Inc. <br /> ADDRESS 7 <br /> CITY, STATE,ZIP <br /> PHONE CA _95241 <br /> r 7 END DUMP BOTTOM DUMP TRANSFER_ <br /> J _ a U <br /> SIGN TU OF AUTHOR17AU AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> q r oZFj Ij U Fj <br /> 4. 1�MAO' 6 <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 /> FACILITY TICKET NUMBER DEBRIS U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> -- ----- .-- ... - ------- - U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 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 C50PY MANIFEST#15 0 911 <br />