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.QKeller Panyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island IN <br /> Sai'nitary Landfill Landfill Sanitary, Landfill n Sanitary Landfill Landfill <br /> 901 Bailey Road, .28979 Coffirl,Butte Rosid 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsbtarg,CA 9565 Corvallis,.OR 97330 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> s Phone(925)458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9691 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> [PHONE <br /> RATOR WASTE ACCEPTANCE NO. <br /> wte Rea�c+Ltxaa <br /> NG ADDRESS6939 <br /> Z025 W,Rgatm Ave <br /> STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ,CA 9520.3 5GLOVES ❑GOGGLES ❑RESPIRATOR )bHARD HAT <br /> . 469-0625 ❑TY VEK ❑ SAFETY VEST <br /> ACT PERSON <br /> t. Wom 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,has been property <br /> described,classified and packaged,and is In proper condition for transportation a cording 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 certity and warrant that the waste has been treated in RECEIVING FACILITY _ <br /> accordanos with the requirements of 40 CFR Parl 268 and is no longer a hazardous waste as defined try _ <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> Q DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.Elaztditoti Ave STOCKTON <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> W Trufker 1 . 1 9 <br /> ADDRESS <br /> 2710 <br /> LomWs <br /> CITY,STATE,ZIP <br /> 3tQd1Q1,1CA 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (20 45C,114, <br /> SIGNATUR F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN DRUMS <br /> t 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 />! REMARKS 0 CONSTRUCTION <br /> FACILI ICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURMF APTHORIZED AGENT, DATE <br /> ❑WOOD <br /> ❑ASH <br /> * ❑SPECIAL OTHER <br /> SCHEDUL14GMY§f BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED AFIRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REI U ,A UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> �e'+DAY <br /> pBEFORE. <br /> 01tNERATOR COPY MANIFEST# L7,�k+�U°3' <br />