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' ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island e�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 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 /> GE !.ER TOR WASTE ACCEPTANCE N0. <br />' MAILING ADDRESS <br /> AV—e, 2328 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />' PHONE ❑GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> 1.409.1 5933-074 C]TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br />' GENERATOR S CERTIFICATION I hereby certify Vat thalifo code named material is not a hazardous <br /> waste as deflnad by 40 CFR Part 261 or title 22 0l the caof regulallons has been property <br /> described rdassrried and packaged and s in proper oonddion for transportation a'cording to appricable <br /> regulalwns AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br />' sublecttothe Land OWposalRestnctions ttartrlyand warrantthat the waste has been treated I" RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a harardoees waste as defined by <br /> 40 CFR Part 261 <br /> W E TYPE <br /> /SQISPO$AL U SLUDGE <br />' Q C STRUCTION ❑WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 West Sonoma SL STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBERTRUCK NUMBER <br />' Co. <br /> ADDRESS <br /> 351 N <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 20136&6175 ❑ ❑ - ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DR ER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑LU <br /> ❑ ❑ ❑ <br /> * l <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 /> IFIEMARKS U SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Qr NON.FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DAT ASBESTOS <br /> o WOOD <br /> U ASH <br /> U SPECIAL 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 /> I: 7 7 /1 n <br />