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❑ Keller Canyon ❑ Qx N untain 140Wby)'6IaB'd, ❑;ForWard <br /> .Fanitary Landfill Sanitary Landfill Sanitary Landfill Lan011 <br /> 901 Bailey Road 12$10 San Ar 4teo Road 1601 Dlxon LagdIgg Road 9999 S,Austin Road <br /> Pittsburg,CA 94565 Halt Moon Bay, CA 94019 Iilliloita8,CA06W, Mant ,CA 95336 <br /> Phone(92`5)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(65017,26-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> IP <br /> ENERATOR WNAS1'E ACCEPTANCE NO. <br /> ary am ex <br /> AILING ADDRESS16S3 W a nut Street # 3 <br /> ITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton CA 95203 a GLOVES O GOGGLES D RESPIRATOR ❑HARD HAT <br /> HONE <br /> 530 _55399 D TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dave Threltall <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE FATE <br /> f <br /> G RA7oR�CER7ll tCATION hereby oettiy that the atsove named meledal b not a hazardous <br /> sts as Mined by 40 CFR Pan 261 or tilt 22 of dw CaNarrda code of raV aKana has been pmpwM <br /> described daunm and pwitaged and Is In proper oordltbn for b"P60Aw a mngnl7 to appkAble <br /> regufabons AND,K the wade Is a trasbnerd residue of a prevfoutly nobicted hazgrdws waste <br /> suited to the lana Disposal Aestridbns I ceNY ens warrertt that the wadelras leen treated In RECEIVING FACILITY <br /> accordance w8h the nx;Wmments of 40 CFR Pan 266 and le no tonper a hazardaoa waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> Q DEBRIS D OTHER <br /> O SPECIAL WASTE -" <br /> GENERATING FACILITY <br /> 1876 Country glob Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHIC LIC NSE NUMBS TRUCK NUMBER <br /> ADDRESS �6 <br /> a <br /> 3896 Eld_r Crook Rd <br /> CITY, STATE, <br /> CA 25822 <br /> PHONE- ENO WMP BOTTOM DUMP TRANSFER <br /> SIGNORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> i L) ❑ ❑ ❑ <br /> 11 CUBIC YARDS <br /> I gereby certify that the above named material has been 18 Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> IS true and accurate. <br /> �r�'�{{ �h/� <br /> DISPOSE OTHER <br /> — 1 U SOIL-, a {,6 .4 L i <br /> REMARKS <br /> _ O CONSTRUCTION <br /> FACILITYTICKET UMBER 5 <br /> D NON-DEBNON-FRIABLE <br /> ASBESTOS <br /> SI NATUKEAWALYrHORIZEDAGENT DATE <br /> ©WOOD <br /> I O ASH <br /> 7k I �D O SPECIAL OTHER <br /> SCHED G M BE MADE PRIORTO 3 00 P.M.THE AY P' <br /> RIOR"*EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIE 'A ST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> _ PORTEf!COPY— _ ;ttAANIFEST <br />