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y; ..anyon ❑ OX Mountain ❑ Newby Island E3 Forward <br /> } nary Landfill AWitary Landfill SanitarAWndfill Landfill <br /> � iley Road W10 San Mateo Road 1601 Dixoding Road 9999 S.Austin Road <br /> ,aiburg,CA 94565 Haft Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> hone (925)458-9800 Phone (650) 726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> _w 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. <br /> 234 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> VjLOC On , UA 95209 <br /> Q GLOVES ❑GOGGLES ❑ RESPIRATOR ff HARD HAT <br /> PHONE <br /> (209)478-1614 ID TY VEK ID OTHER <br /> CONTACT PERSON <br /> EddNiemann SPECIAL HANDLING PROCEDURES: <br /> SIGNA OF AUTHORIZED AGENT/TME DATE <br /> 12111100 none <br /> GENERATOR'S CERTIFICATE N:I herebyhertify that the above named material is not a hazardous <br /> waste as defined by 40 CFR 261 or tide 22 of the California code of regulations,has been properly <br /> described,classified and pacli5aged.and is in proper condition for transportation according to applicable <br /> regulations;AND,If 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 treated in40 CFIR RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> Pan 261. Forward Landfill <br /> WASTEASTETYPE: 9999 S. Austin R,d. <br /> ISPOSAL O SLUDGE <br /> *CONSTRUCTION QWOOD ____k4'a_ntc-rai CA 2,152233 <br /> Q DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> North Stockton Auto Service <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim <br /> ADDRESS Thorpe Oi3 Inc. <br /> f `�3L✓ <br /> P.O. Box 337 <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 3 Q Q <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 12/1100 7� <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 /> SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED GENT OR DRIVER DATE ASBESTOS <br /> ❑WOOD <br /> r <br /> Q ASH <br /> / U SPECIAL OTHER <br /> SCHEDULING MUST BE MADEPRIORTO 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 /> GENERATOR COPY MANIFEST# <br />