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❑ Keller Canyon ❑ Ox Mountain ❑ Newby IslandForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill l 1r~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) 726-1819 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> Cflly � <br /> MAILING ADDRESS 2328 <br /> S ire: <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stocktom.CA95202 U GLOVES O GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> 1(209)937-8374 O TY VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> �1a <br /> SIGNATURE OF AU HORIZED A ENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION i hereby dertify 14&A above named material Is not a hazardous <br /> waste as defined by 40 CFR Pact 281 or life 22 of the California code of reguiatlons has been Property <br /> described,classified and packaged and is In proper condition for transportation a-=ding to appiicable <br /> regulations AND,If the waste Ls a treatment residue of a previously restricted hazardous waste <br /> su6lect 10 ltre tatty plsposai Restrictions f certify and warn"that the waste fres been treated In RECEIV W G FACILITY <br /> ecoordance with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261 <br /> W S TYPE <br /> ISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> C1 DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1.18 Weal gofnoma 8t. STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> oRCiIX !d �� <br /> ADDRESS <br /> 351 Nall$Baia Rd <br /> CITY, STATE,ZIP <br /> CA95240 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209136"175 Jff ❑ ❑ <br /> SIGNATUR F AUTHORIZED AGENT OR DRIVER DATE RO - 5 FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> I accepted and to the best of my knowledge the foregoing DISPOSAL METHOI) (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> I ❑HON-FRIABLE <br /> RESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D <br /> /t]A <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM 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 /> MANIFEST# 1 97717 <br />