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❑ Keller Canyon ❑ Ox Mountain ❑ Newby IslandXnNill <br /> rd <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill <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 /> IPhone (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 />' MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br />' PHD E <br /> ❑TY VEK C]OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> mom nuvy <br />' SIGNATURE,OF AUTHORIZE AGENT/TITLEDATE <br /> ."IV#9 <br />' GENERATOR$CERIIFI ATION IAide E cerl;i the abwe named material Is not a hazardous <br /> Waste as defined try 40 CFR Part 261 or M 22 of the Caidornia code of reguiations,has been property <br /> described classified and packaged,wd is in proper condition for transportation alcording to applicable <br /> regulations A04m if As waste is a t esi neat residue at a previously restricted hazardous waste <br /> subject to the Land Disposal Rastrictlorrs I eertry and warrant that the waste has been treated to RECEIVING FACILITY <br /> accordarwo with the req ncements of 40 CFR Part 268 and is no"er a hazardous waste as de0nod by <br /> 40 CFR Part 261 <br /> WAST9 TYPE <br /> A11DISPOSAL ❑SLUDGE <br />' CkCONSTRUCTION ❑WOOD <br /> D QEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br />' 110 West Sow=St. STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS <br /> 35 N <br /> CITY, STATE,ZIP <br />' PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)36"175 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED 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 /> ❑SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> DEBRIS " <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DA O WOOD <br /> ❑ASH <br /> �C ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRI ORTO 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 WrrH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# �'i 7 7 ; ,d <br />