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Canyon E] qW <br /> ountain E] Newby Is d ® Forward <br /> • ° Landfill Itary Landfill Sanitary dfIII Landfill <br /> 4,,, itary <br /> aileyRoad ' 12310 San Mateo Road 1601 Dixon Landing Road9999 S.Austin Road <br /> urg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> one(925) 458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone(209)982-4298 <br /> ph <br /> ' Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> North Stockton Auto Service <br />/ MAILING ADDRESS <br /> 8709 N. Davis Rd. 234 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockton ,QA 93209 Q GLOVES Q GOGGLES Q RESPIRATOR I&HARD HAT <br /> PHONE <br /> ❑TY VEK Q OTHER <br /> t9.QQ 47R-1614 <br /> CONTAC1F PERSON SPECIAL HANDLING PROCEDURES: <br /> I Niemann <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE/ DATE <br /> * L 12/01/0none <br /> GENERATOR'S CEFrrIF1 00 1 here certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Parl 261 or title 22 of the California coda of regulations,hes been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste Is s treatment residue of a previously restricted hazardous waste <br /> Subject to the land Disposal Restnctions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261. Forward Landfill <br /> WASTE TYPE: 9999 S. Mist i Rd. <br /> DISPOSAL QSLUDGE ;1anteca, CA 95a3F <br /> Q CONSTRUCTION Q WOOD <br /> O DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> North Stock-ton Auto Service <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> III] Thorpe Oil , I" ac . fin' J <br /> ADDRESS <br /> P.C . Box 357 <br /> CITY, STATE,ZIP <br /> PHOI,Odi CA 95241Q03157 <br /> NE END DUMP BOTTOM DUMP TRANSFER <br /> o ❑ <br /> SIGNATVF�E OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> jam) _ � ❑ ❑ � <br /> 12/1/00 <br /> CUBIC YARDS r <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 /> Q SOIL <br /> r <br /> l REMARKS ❑ CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE Q WOOD f <br /> � r <br /> Q ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 .M.THE DA'f PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE MAANIFEST#THE DAY BEFORE. <br /> GENERATOR COPY _-- <br />