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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island X.Forward <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 /> 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 /> CdyQfSWChM <br /> MAILING ADDRESS 2328 <br /> 425 No- h E1 Dmido Ave. <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ShxJdc%CA 95202 0 GLOVES ❑GOGGLES O RESPIRATOR ©HARD HAT <br /> I PHONE <br /> 4 ❑TY VEK ❑OTHER <br /> CONTACT PERSON <br /> rpt SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGE /TITLE DATE <br />' GENERATOR S Wi71FICATION I hereby Witify1fiat th.Fax earned matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the Caldomia code of raguiabons,has been property <br /> described dassirred and packaged and Is In proper oond lion for transportation a-coming to applicable <br /> rggufatl AND,If the waste is a treatment residue of a previoupfy restricted hazardous waste <br /> =to"o t.and Disposal Restnctions I-rtrty and warrant that the waste has been treated In RECEIVING FACILITY <br />' ce with Ilre requirements of<0 CFR Part 268 and Is no ionger a hazardous waste as defined by <br /> 40 CFR Part 264 <br /> W TYPE <br /> DISPOSAL O SLUDGE <br /> ONSTRUCTION ❑WOOD <br /> ❑D RIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br />' 114 wed Saf�St: STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Oil Co► <br /> ADDRESS <br /> 351 Nadi Beckpo RdL <br /> CITY, STATE,ZIP <br />' Ladi,CA 93240 <br /> PHONE EN UMP BOTTOM DUMP TRANSFER <br /> 7 ❑ U. <br /> 51GNATU OF AUTHO ED AGENT OR DRIVER DATE ROL F S FIAT-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 BOTHER <br />' MAU kOIL <br /> ERKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br />' ASH <br /> ❑SPECIAL OTHER <br />' SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.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 C 7 7 A I <br />