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❑ Keller d#pyon ❑ Ox Mountain, - U Newo �@iar>!QE a �+�!t�¢••� , <br /> .Sanitary=E.ondfili Sanitary LOndfiil ! Sanit` t>Iir�,L`'andfl1l L�ttrdfi�i <br /> 901 Bailey R(Ao . 12310 San Mpteo Road 1501 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA�4565 Half Moon Bay;CA94019 Mil�das, A50 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726.1819 Phone(408)945.2800 Phone(20)982-4298 <br /> Fax(925)458-9891 Pax(650)726-9183 Fax(408)262-2871 FAx(209)982.1009 <br /> • -- , <br /> � NON#iAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Mafy Sanc ez <br /> MAILING ADDRESS <br /> Cl633 W_ Walnut Street <br /> TY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> D GLOVES ❑GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENE -10R S CERTiFI 10N !hersbY C"'y Ihat the above nerrtad material Is t5aeebee+ ProP•e dY <br /> was as defined try 40 GFR Pan 261 or lith 21 CO Uie Ce6fomte coda o!reprdatbns. <br /> de a•d.etassltiea end padcnged and m In proper oandiMon for trarmportddon ax«dtnp to appdeabte <br /> sugbje�et m m�[s a n Re1si t omerty a�`na warranttn,e+ e n� tie RECEIVING;FACILITY <br /> actordenca with dra raquiremente 040 CFR Part 266 and tm no longer a hezerdoue wants as defined M <br /> 40 CFR Pert 261 <br /> WASTE TYPE <br /> O DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION 0 WOOD <br /> O DEBRIS ❑OTHER <br /> a SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Gauntry Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> r <br /> CITY, S <br /> PHONE END DUMP BOTTOM DUMP SFER <br /> SIGNAT A RIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I herhby certify that the above named materlaffias been 1$ Yards - <br /> I 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 /> z U SOIL <br /> ih <br /> EMARKS a 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBERNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE OOD <br /> O ASH <br /> ,k 4 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M.THE DAY PRI tTo EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAIIYY DELIVERI MUST FOULED WITH THE LANDFILL I �THE DAY�f RE <br />