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❑ Keller Canyon YV ❑ Ox Mol nta r� r © RowoY 1818jiqm �/y'}' _ u r orw <br /> ri <rt f '� K r M�+^1`F Y� '11 "q i <br /> Sanitary Landfill _ Sanitary Landfill Sanitary Land t Landfill <br /> 901 Bailey Road 12$10 San Mateo Road 1601 DixonLAndipp'll 9999 S.Austin Road <br /> Pittsburg.CA 94565 Half Moon Bay,CA 94019 Milpitad,C,�9t035, Manteca;CA 8$338 <br /> Phone(925)458-9800 Phone(650)726-1819 Phona{4013)9 800 Phone(209)982.4298 <br /> Fax(925)458-9891 y Fax(650)726-9183 Fax(408)292-2$ i Fax(209)982-1009 <br /> NON,-HAZARDOUS WASTE R# NIFE$T <br /> GENERATOR WASTE ACCEPTANCE NO, <br /> MAILING A DRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONECA 95203 <br /> O GLOVES a GOGGLES U RESPIRATOR 0 HARD HAT <br /> 55 O TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE___l DATE <br /> s <br /> * a' 4 X I4 <br /> GEN R'S CERTIFICATION I hereby cerUty that the abov&named material Is not a hazardous <br /> wqstb as defined by 40 CFR Part 291 or Utle 22 01 the CagWrda coda at reglatlons.has boar properly <br /> described dassilled and packaged and Is In proper conddion for transportation ajoordk'g 10 appkWe <br /> regulations AND,It the waste Is a treat"wM roaidue of a Previously restricted hazardous wsate <br /> so*--'Ia the t r nd Disposal Reatridiora,i owirry and warrant that the waste has been treated In RECEIVING FACILITY <br /> aocordawe with the nlgWnmwnts of 40 CFR Part 269 and is no klnper a hazardous waste as deflned by <br /> 40 CFR Part 261 <br /> WASTE TYPE - - - - <br /> Q DISPOSAL U SLUDGE <br /> Cl CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSI,=r�NUMBER TRUCK NUMBER <br /> Sons Tilicking Inc ADDRE S <br /> CITY,ON,909F Gveek Rd <br /> PHONE SaGmmeptQGA END DUMP BOTTOM DUMP TRANSFER <br /> SIGNA RIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material hes been 18-Yards - <br /> accepted and to�he best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> � �" MADS [l qj p4r> ,.u} > i< :�,�.�+i-1.. t < <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> 4SIGNATURE OF THORIZEDAGENT DATE U WOdD <br /> E]ASH T ` <br /> * {`� 9 $PECIALQTIJER IL � <br /> i <br /> SCHEDULING MUST BE AQE PRIOATO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNiCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AR WAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> — _ _ — ----TRANSPORTER GOPY _ MANIFEST# <br /> 52890 <br />