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I ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island orward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill 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 /> Phone (925)458-9800 Phone (650)726-1819 Phone(408)945-2800 Phone(209) 982-4298 <br /> 0 Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> I NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Cdy of'loci hm <br /> MAILING ADDRESS <br /> 5Ave. 2328 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CA95202 ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br />' PHONE <br /> Z09 937,074 ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> r� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AQ&ENT/TITLE DATE <br />' <br /> GENERATOR S CERTIFICATION I hereby certity that 0te above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Calitomla code of regulations has been properly <br /> described,classified and packaged and Is in proper conddm for transportation axDrding to applicable <br /> regulations AND,if the waste Is a treatrnent residue of a prevfousty restricted hazardous waste <br />' subject to the Land Duposei Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 GFA Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WA TE TYPE <br /> iSPOSAL ❑SLUDGE <br /> ❑ NSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> I110 wcat saenam St. STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I oil[cos or 64z I Q 7-7 /-P7''o <br /> ADDRESS <br /> X <br /> 351 .�ji`>< .�.P.s� <br /> CITY,STATE,ZIP <br /> I LAACA 45240 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> M 36"175 SIGNATU OF AUTHORIZED AGENT O DRIVER DATE ROLL--OFF(S) FLAT-BED VAN DRUMS <br /> I ❑ ❑ ❑ ❑ <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 /> F11=-MARKS <br /> ❑CONSTRUCTION <br /> FACT ET BER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIG FjAU1­WMIZEDAGV,NT DATE <br /> ❑WOOD <br />' ❑AS <br /> PECIAL OTHER <br />' SCHEDULING MUST BE MADE PRIORTO 3:00 P M THE dAdPRiopiro EXPECTED ARRNAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> ____ MANIFFAT S w r% 7 7 n 7 <br />