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.'� Canyon El dWountain y ❑ Newby Isod Forward 5:y= ary Landfill Sanitary Landfill Sanitary Landfill Landfill ` Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road "f Manteca,CA 95336 sburg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 y'hone(925) 458-9800 Phone(650)726-1819 Phone (408) 945-2800 Phone (209) 982-4298 Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 ' Fax(209)982-1009 NON-HAZARDOUS WASTE MANIFEST - GENERATOR WASTE ACCEPTANCE NO. North oc ton u o ervice MAILING ADDRESS — 3 t37U9 N. Davis CITE STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT Stockton CA 95209 a GLOVES ❑GOGGLES ❑RESPIRATOR �HARD HAT PHONE ❑TY-VEK Q OTHER CONTACT PERSON SPECIAL HANDLING PROCEDURES: iernann SIGNATURE OF AUTHORIZED AGENT/TITLE DATE �q 1211I�U none GENERATOR'S CER EFIC#fi0N:I hereby certify that the above named material is not a hazardous wasteas defined by 40 CF Pan 261 or title 22 of the California code of regulations,has been properly described,classified and packaged.and is in proper condition for transportation according to applicable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY accordance with Me requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by Or�Vgr all 40 CFR Part 261. WASTE TYPE: 9029 S. A 5t ' n Rd. DISPOSAL O SLUDGE Z)CONSTRUCTION D WOOD Manteca, C9 95336 Q DEBRIS ❑OTHER ❑SPECIAL WASTE GENERATING FACILITY North Stockton tlu4o Service NAME NOTES: I VEHICLE LICENSE NUMBER TRUCK NUMBER Jim Thorpe Oi , nc . l� - 'J 71a I- w- % ADDRESS P.0. PQx 35 CITY, STATE,ZIP 4- a ! - PHONE END UMP BOTTOM DUMP TRANSFER 9)366- 1 ❑ ❑ SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS 12/1/00 CUBIC YARDS 1 hereby certify that the above named material has been 15 accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) is true and accurate. DISPOSE OTHER A IL REMARKS Q CONSTRUCTION DEBRIS FACILITY TICKET NUMBER Q NON-FRIABLE Z 11 ASBESTOS SIGNATURE OF THORIZED AGENT OR DRIVER DATE Q WOOD f Q ASH ' ( _ / U SPECIAL OTHER i SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE MA NDFIL#THE DAY BEFORE.