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I ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island rward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill L ndfill <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)726-1819 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 /> INON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2325 <br /> Ave. <br /> CITY,STATE,ZIP REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> Skm*tc%CA 95202 O GLOVES E]GOGGLES 0 RESPIRATOR Q HARD HAT <br />' PHONE <br /> (209)W7-5374 E3 TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED PrpENT/TITLE DATE <br /> I oeNERATon s CEFmFtCA110N 1 ertily the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the Ca ibmia Code of regulations has been Properly <br /> described ciasslffed and packaged and is in proper condition for transportation a-=riling to applicable <br /> ragtdatkxu.ANO,if the waste is a traatment residue of a prevfou*restricted hazardous waste <br /> subject to the Land Disposal Restrkxiorrs I certify and warrant that the waste 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 W <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL O SLUDGE <br /> •CONSTRUCTION U WOOD <br /> •DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br />' 110 west SaDoMa RL STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' Oil Ctrl. <br /> ADDRESS <br /> 351 Nam Bad Bd <br /> CITY,STATE,ZIP <br />' CAi.95240 <br /> PHONE ENQ MP BOTTOM DUMP TRANSFER <br /> 36&6175 ❑ <br /> SIGNATURE OF AUTHORIZED A.PENT OR DRIVER DATF, ROLE-OFF(S) FLAT-BED VAN DRUMS <br /> V), U& (h ;. - � t uk_� L) <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 />' n SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> OOD <br /> I Q ASH <br /> U SPECIAL OTHER <br /> SCHEDUUNG MUST BE MADE PRIORTO 3 00 P M 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 /> _� ___ MANIFEST# 1 9 7 7 9 (4 <br />