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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island *forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill andfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road ~9999 S Austin Road <br /> Pittsburg,CA 94565 Halt Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone (650)726-1 B19 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 2328 <br /> 05 Nw&F1 Dmado Ave. <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Mod*mCA95202 U GLOVES 4 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> (209)937-W74 0 TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> mwuis <br /> SIGNATri OR OF AU O D AG T/TITLE DATE <br /> GENERATORS CERTIFICATION I hereby CAMY above named material Is not a hazardous <br /> waste a$defined by 40 CFR Part 261 or We 22 of the California code of reguiabons has been property <br /> described ctassiried and packaged,and is in proper condibon for transporlation a-cording to applicable <br /> regulations AND,it'the waste is a treatment residue of a previously resulcted hazardous waste <br /> subject to the Land Dtsposat Restrictions I codify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance voth the requirements of 40 CFR Part 268 and rs no longer a hazardous waste as dehned by <br /> 40 CFA Part 261 <br /> WAS TYPE <br /> DISPOSAL 0 SLUDGE <br /> 0 STRUCTION ©WOOD <br /> 0 DEBRIS U OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1110 weal SODOM St. STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> T�oil Co. <br /> ADDRESS <br /> 351 Norda Beda nm Rd. <br /> CITY, STATE,ZIP <br /> CA 95240 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 368-6175 <br /> SIGNATURE OF AUTHORI2ED AGENT OR DRIVER DATE ROLL-OFF(S) 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 /> 0 SOIL <br /> EMARK5 <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NU ❑NON-ER ON- S <br /> FRIABLE <br /> ASBESTOS <br /> SIGNA RE OF THORI DATE <br /> ❑WOOD <br /> ❑ASH <br /> 0 S CIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M THE D Y PRI RTO 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 /> MANIFEST# 'I CZ 7 7 A I <br />