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rayon ❑ Mountain ❑ Newby I nd Forward <br /> Landfill 4Witary Landfill SanitaryWndfill Landfill <br /> ,ay Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> �e( 95336 <br /> 9 5)58-9800 Phone,CA 94565 Half o650 726-18on Bay,CA 19 19 PhoneMilpitas 08 9452800 Phone(209)982-4298 <br /> .";1(925)458-9891 Fax(6 d)726-9183 Fax(4 8)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> T <br /> A LI ADDRESS <br /> 0 <br /> 8709 N. Davis Rd. <br /> _ 234 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S'tockton CA 93209 U GLOVES U GOGGLES U RESPIRATOR CHARD HAT <br /> PHONE <br /> Q TY-VEK L1 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> T <br /> SZNA`tW-0VA'UTHORIZEP AGENT TITLE DATE <br /> 12/1/OC none <br /> GENERATOR'S CERTI ATI :1 hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR art 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treatedin RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as deleted by <br /> 40 CFR Part 261. Forward Landfill <br /> WASTE TYPE: <br /> Z2 DISPOSAL U SLUDGE 9993 S• Austin RG.t . <br /> ❑CONSTRUCTION 7 WOOD S:kNxk$ISx Manteca-, CA 9J3:315 <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> North Stockton Auto Service <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1 <br /> ADDRESS i n c A J ` <br /> - <br /> CITY, STATE, ZIP <br /> LOdl , J ­J D <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �C ilL/1 ' '� 12/1/Q <br /> CUBIC YARDS , <br /> 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 /> SOIL - <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICK�NUMSER DEBRIS <br /> U NON-FRIABASBESTOS <br /> SIGNATURE OFAUTHO IZED GENT OR DRIVER DATE <br /> U WOOD <br /> j U ASH <br /> /dz <br /> 4 ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE CHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> 1 G3ENERATOR COP , MANIFEST# <br /> t <br />