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❑ Keller Canyon ❑ Ox Mountain U newpy:15l0;11u, ° �••-�•-- <br /> ' unitary Landfill Sanitary Landfill $anijary Landfill Wifili <br /> ic <br /> 0 5rn Mateo Road 1601 Dixon Landing-Road 9999 S Austin Road <br /> 1231 <br /> 901 4iley Road Half 0 S 'Bay,CA 94019 Milpitas,CA 95W6 Manteca,CA 95336 <br /> n <br /> pittsburg,CA 94565 Phone(408)945-2800 Phone(209)982-4298 <br /> phone (925)458-9800 Phone(6,50)726-1819 Fax(408)262-2871 Fax(209)982-1009 <br /> Fax(925)458-9891 Fax(650)726-9183 <br /> 0 _ NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING A DRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTE T UIPMENT <br /> ❑GLOVES ❑GOGGLES O RESPIRATOR 0 HARD HAT <br /> PHONE ❑TY VEK ❑OTHER <br /> CONTACT PERS N SPECIAL HANDLING PROCEDURES <br /> SIGNATU E O AU ORIZED AGENT/TITLE DATE <br /> GENE OR S CEFMFICANON I hereby Certify that the above named to 's not been <br /> ardous <br /> wa3 as defined by 40 CFR Pert 281 or title 22 of the CaGfofrnk Code of regi enoordklp to - <br /> described cdassifted and packaged and Is in proper property <br /> oordrtr*n for transporffi <br /> regulations ANO,If the waste Is a tloab*md residue of a prrwlousN aestrEctbd hazerdow west* <br /> subject to the Land Disposed Restrictions I Cer*fy and warrant that the waste hire been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 288 and is no kxngar a hazardous waste as defined by <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> Q DISPOSAL O SLUDGE <br /> 0 CONSTRUCTION O WOOD <br /> Q DEBRIS Q OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> i 876 Country Club S1vd, Stockton, CA 95203 <br /> NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> TRANSPORTER <br /> sons T <br /> ADDRE <br /> CITY, S <br /> PHONE END DU BOTTOM DUMP TRANSFER <br /> ee SIGNA ARIZED AGENT OR DRIVER DATE RO_L-OFF(S)—.11-11111111 FLAT-BED VAIN DRUMSLl <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS Yards <br /> accepted and to the gest of My knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. DISPOSE OTHER <br /> ❑ SOIL <br /> nwl's 1{ f <br /> FIEMARKS 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOSIGNATUREJQrzA THORIZ AGENT DATE 13 WOOD <br /> \ a ASH <br /> * + ECIXC OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES TRNSISPOR ER COPY SCHEDULED WITH THE MANIFFEST#NDFILL Til R <br /> BE 52922 I=. <br />