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anyon ❑ c&ountain ❑ Newby Is* ❑ Forward <br /> ary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 1 Bailey Road 1 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650) 72k-9183 Fax (408)262-2871 Fax (209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> [GENERATOR WASTE ACCEPTANCE NO. <br /> Nolt:th Stockton Auto Service <br /> ILINGADDRESS <br /> d, 234 <br /> _8709 N. Dayis R <br /> TY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHO E qf;2Qq <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR IN HARD HAT <br /> ❑TY-VEK El OTHER <br /> CO N <br /> Ed Niemann SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE ,, DATE <br /> none <br /> GENERATOR'SERTIFICATION01F,,.by.e dy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part tlethe California code of regulations,has been properly <br /> described,classed and packaged is in proper condition for transportation according to applicable <br /> regulations;AND,it the waste Is a treatment residue of s previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. Forward Landfill <br /> WASTE TYPE: <br /> DISPOSAL a SLUDGE I'=i94 S. A]t}t-1 n J d <br /> ❑CONSTRUCTION ❑WOOD Mantwca, CA 05336 <br /> ❑DEBRIS Q OTHER <br /> ❑SPECIAL WASTE <br /> ENERATING FACILITY <br /> or Stockton Auto Service <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim 'Tbornp Oil , n C . 11 c' <br /> ADDRESS <br /> CI l� R Box 337 <br /> STATE, <br /> Lodi , CA 95241-0301 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368=617: ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> 12/1/00 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 15 <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 /> REMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET N ER/ ❑ NON-FRIABLE <br /> � ASBESTOS <br /> IGNATURE PAUT OPIZED AGENT OR DRIVER DATE <br /> O WOOD <br /> ❑ ASH <br /> ❑ SPECIAL 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 MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> r_CMr0Arna f+nov I MANIFEST.#_.__. <br />