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F] Kelter Canyon ❑ Ox Mountain ,11 Newby Island ❑ Fosn��Kq. <br /> anitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Lgnoing Road 99,99 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 AllBntbbel,CA 95 39 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)90-2800 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 /> Maly ounchez <br /> MAILING ADDRESS Street <br /> # 1 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton, CA 95203 U GLOVES O GOGGLES 0 RESPIRATOR Q HARD HAT <br /> PHONE <br /> 530 668-5399 ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dave Threlfall <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENws CERTIFICATION 1 hereby Derby shat the abate mnwd material Is roha <br /> t a zardous <br /> wast s dented by 40 CFR Part 261 or We 22 at the Caftm►a code of reguUMOM has been Properly _ <br /> described classified and padragad and Is In proper condtion for transportatlon avordirtg to epp6rabb <br /> regulatlahs,AND,H the waste Is a treahrre I residue of a previously restrlcled haurdous waste <br /> subled to the Land Disposal Restrictions I cervy and warrant that the waste has been Healed to RECEIVING FACILITY <br /> socordanca with She recorernerna of 40 CFR Pad 266 and to no bnger A Hazardous waste as deflrwd by <br /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> O DISPOSAL ©SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> ❑DEBRIS ©OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1676 Country Club Blvd, Stockton, CA 95203 i <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> to <br /> ADDRESS <br /> 8806;:IiAr Creak Rd <br /> CITY, STATE,ZIP <br /> PHONEaCranl CA 95828 OntoEND DUMP BOTTOM DUMP TRANSFER <br /> SIGNA ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> :NUMBEFI <br /> CUBIC YARDS <br /> I hereby cthe above named material has been 18 Yards <br /> accepted best of my knowledge the foregoingDISPOSALMETHOD (TO BE COMPLETED BY LANDFILL) <br /> true and accurate. <br /> DISPOSE OTHER <br /> ,Q SOILEwMARKS 0 CONSTRUCTION <br /> FACILITY TICDEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUR U IZED AGENT DAT <br /> O WOOD <br /> ASH <br /> i Asx rr. <br /> * ❑SPECIAL OTHER ►;, r_ r <br /> SCHEDULING MUS 8E 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 /> COPY _ __ ______ MANIFEST fl `522 <br />