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IJ Keller Cany.Q,n ❑Coffin Butte ❑Ox MountaI ri. ❑ Newby Island ® Forward <br /> Sanitary Landfill, Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> IL 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> f Pittsburg, CA 94565 Corvallis,OR 97330 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)982-4298 <br /> Fax(925)458-9891 Fax(54 1)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE.NO. <br /> He irobwRaK"VM <br /> MAILING ADDRESS 6939 <br /> m vc — <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> cn CA GLOVES ❑GOGGLES U RESPIRATOR XU HARD HAT <br /> PHONE <br /> 209 _0625 ❑TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> BrdtCcru om SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR's CERTIFICATION:I hereby cartIfy that the above named material isnot a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and Is In proper condition for transportation wording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous.waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 288 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> iii DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD ' <br /> O DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY - <br /> 2025 W.Huciton Ave STOCKTON <br /> TRANSPORTER NOTES: I VEHICLE LICENSE NUMBER I 'TRUCK NUMBER <br /> W Truldtcrr 7� �� <br /> ADDRESS <br /> 2719 LoQu is RAd <br /> CITY,STATE,ZIP <br /> Studd o(-4CA 95205 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)456-1145 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS 'FLAT=BED- VAN DRUMS <br /> MAA <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 /> is true and accurate. DISPOSAL METHOD: (Tp BE:COMPL ED BY'LANDFILL) <br /> DISPOSE OTHER. <br /> ❑SOIL i <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET R NUMBEDEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER l <br /> rN it <br /> SCHEDULING MUST BE MAgE 3 IORTO 3:00 P M.THE DAY PRIORTO-EXPECTED ARRIVAL!ANY UNSCHEDULED'LOADS'ARE SUBJECT <br /> TO REFUSAL UPON ARRI'S&/pAL ONGOING DAILY DELIVERIES MUST:BE SCHEDULED WITH THE_LANDFILL_THE DAY[[BEFORE' <br /> ,;gFNERATOFR MANIFEST# 4.J ., ' <br />