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El Keller'Canyon ,; ❑Coffin Butte ❑Ox Mountain .._ "❑ Newby Islend IN Forward <br /> •Sanitary Landfill Landfill Sanitary Landfill" Sanitary Landfill Landfill <br /> i' 901 Bailey Road r 28972,Coffin Butte Road 12310 San Mated Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis,OR 97,330 Halt Moon Bay,CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)98 2-4298 <br /> Fax.(925)458-9891 Fax(541)745-3626 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE-MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hmdwat er Re marem <br /> MAILING ADDRESS <br /> ZU13 W."aZe ton Ave 6939 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> StoddatrCA 95203 GLOVES ❑GOGGLES O RESPIRATOR XO HARD HAT <br /> PHONE <br /> 469-0623 O TY-VEK O SAFETY VEST <br /> CONTACT PERSON <br /> Brdt,CcllilKn SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that 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,hes been property <br /> described;otseellled and packaged,and is in proper condition for transportation according to applicable ; <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I ceitify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wilh the requirements of 40 CFR Pad 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> O DEBRIS CI OTHER <br /> U SPECIAL WASTE' <br /> GENERATING FACILITY <br /> 2025 W.H MI;an Ave STOCKTON <br /> TRANSPORTER l NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBERr, <br /> ADDRESS d e �( I D <br /> . <br /> 271 0 T�anuv.Reed <br /> CITY,STATE,ZIP <br /> tadctatn,GA 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Z 456.1145 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED- VAN DRUMS <br />'r <br /> AM 0 Q -07 <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: " (TO BE COMPLETED BY LANDFILL),-. <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS . U SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ,. aNDN-FRIABLE..' <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCH 91dL NG MUST BE MADE PRIOR TO 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 LANDFALL THE DAY BEFORE. <br /> GENERATOR COP`( MANIFEST# b`� <br /> f .J <br />