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❑ Kellar Cgnyon ❑ Ox Mountain LJ- NOWDY�$IaI9Q ;, u- o v,c+�l u <br /> Sanitary Landfill Sanitary Landfill til'riifitiLa df'III l ti dfIIit <br /> 909 BailQy Road, 12314 San Mal Road i 1601 Dizon Iran In Road 8999 S Austin Road <br /> Pittsburg,CA 94665 Half Moon Bay,CA,'040119 `' Mllpitk._'CA 957 - LJ1EChteo,CA 953 fi <br /> Phone(925)458-9800 4 Phone(650)726-1819 Phorle(408)W,2800 Phone-(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fait(409)X62-2871 Fax(20g)982,1609 <br /> NQN-HAZ411DOUS W�qT� MA <br /> NIPPAT - <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ,— <br /> CITY, STATE,ZIP REQUIRED PERSONAL PRQTECTtVrE EQUIPMENT <br /> PHONE CA 95203 SWrldon, U GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> 53f)668-r,'AQQ O TY VEK a OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TINE DATE <br /> GRATOFrS CERTIFICATIOtt 1 hereby certify that the above named maWW W ft hazardous <br /> WW <br /> as defined by 40 CFR Part 261 or title 22 of On Cafilornla code of repulaWM hos been pray" <br /> described daaslfied and padwgW and Is In proper conddon far transportallon vtadb v to apokxae <br /> repuiaWns AN06 H the waste Is a bestmeM residue of a prevlousty reableted hersrdorts waste <br /> aordance»with�tlwDisposed <br /> rortriFrement FR Part 266 ar no band waffard r4por hazardrdous wabasnste ass deriitsd by RECEIVING FACILITY <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPQSAL O SLUDGE <br /> •CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club 13W, Stockton, CA 95203WON <br /> ; <br /> TRANSPORTER i MOTES VEHICLE UCENSE NUMBER TRUCK NUMBER <br /> Int- <br /> ADDRESS /�f I <br /> 1 <br /> CITY,SAd- <br /> TATE,ZIP <br /> PHONE Q=mmeatcEND DP BOTTOM DUMP TRANSFER <br /> 51GNAT A RiZED AGENT OR DRIVER DATE ROLL-0FF S 1=LAT BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been _1$ Yaa<da - <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> Ay <br /> 1,A EMAIKS - w ., +1 s w as r1.V9Grr+.' 75L'sti"l.r <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBEFY DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOPIZISD AOENT DATE <br /> d WOQD <br /> SCHEDULING U BE MADE PRIORTO 3.00 P M.THE DA P IOR ECTED ARRIVAL'-ANY UNSCHEDULED LOA&ARE SUBJECT <br /> TO REFUSAL U ON ARRIVAL. ONGOING DAILY DEL IES MAST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TRANgPOF"R COPY _z_ MANIFEST# ,5 28 92 <br />