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[_] Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill andfill <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 /> my-wmdaw— <br /> MAILING ADDRESS 2328- <br /> MW-IL LpQffaw 0 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> sualmKCA E U GLOVES U GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHO <br /> ❑TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> numbiardy <br /> SIGNATURE OF AUTHORIZED GENT/TITLE DATE <br /> GENERATOR 3 CERTIFICATION I hereby*W]7&t the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,dassified and packaged,and is m proper condition for transportation a-cordng to applicable <br /> regulations AN0'H the waste is a treatment residue of a previously restrkted hazardous waste <br />' subiect to the Larhd the <br /> Restrictions I certify and warrant that the waste has boon treated In RECEIVING FACILITY <br /> accordance anth the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE PE <br /> "ZIISPOSAL 0 SLUDGE <br /> U CONSTRUCTION O WOOD <br /> ❑DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 West Scam=SL STOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> 351 Nodh Bad==Rd. <br /> CITY, STATE,ZIP <br /> PHONE END MP BOTTOM DUMP TRANSFER <br /> ZOS 368-6175 ❑ ❑ <br /> SIGNA RE OF AUTHORIZ D AGENT OR DRIVER DATE# ROLL!-OFF(S) FLAT-BED VAN DRUMS <br /> )Is A AA 0 <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 /> U SOIL <br /> 111 REMARKS f 1A <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> __jDEBRIS <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT <br /> O WOOD <br /> U ASH <br /> j <br /> O 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 /> ' _ aAaAllf~KCT 8 1 G 7 1 0 r, <br />