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V0M - _ ¢ <br /> .er Canyon El ox Mountain ❑ Newby Island Forward <br /> initary Landfill i Sanitary Landfill SanOn <br /> y Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Halt 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}982-429 <br /> Fax(92::}458-9891 Fax(fi50) 726-9183 Fax(408)262-2871 Fax (209) 982-1009 <br /> ., <br /> NON-HAZARDOUS WASTE MANIFEST <br /> WASTE ACCEPTANCE NO. <br /> MA RE5 -- 234 ` <br /> . - <br /> I <br /> CI , STA ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> i 0 GLOVES ❑GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> Q TY VEK ❑OTHER <br /> ` CO SPECIAL HANDLING PROCEDURES- <br /> SIGNATUFZ OF AUTHORIZED AGENT/TrrLE DATE <br /> I EI I3 <br /> * 1 - 2!1/00 none <br /> li�i <br /> GEMERATQR'S CERTI TIO •I hereby cartity that the above named matenal is not a hazardous <br /> waste as <br /> defined by 40 FR P 261 or title 22 of the CaAtomia code of regulations,has been property <br /> described,ciassWed and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste is a treatment residua of a previously restricted hazardous waste <br /> r subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the"Wraments of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> IQ CFR Part 261. Forward temdf 113: <br /> .W TE TYPE: <br /> ❑DISPOSAL Q SLUDGE 181nt@C81 CA 35336 <br /> " 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br />,. North Stockton Auto Servize <br /> I1 , NA 7ROLL-OFF(S) <br /> : VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> -7 2 <br /> AD R SS <br /> CITY, STATE,ZIP <br /> i� _ <br />' PH UMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNAT E OF AUTHORIZED AGENT OR DRIVER DATE FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> * Alex <br /> CUBIC YARDS <br /> 1 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 /> .'. _ 0 SOIL <br /> •- .~... REMARKS 0 CONSTRUCTION <br /> DEBRIS <br />' ' ' FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUREAUTHORIZED AG NT OR DRIVER DATE <br /> i ❑WOOD <br /> t: ,✓ ! 0 ASH <br /> • , �� 0 SPECIAL OTHER. <br /> :« SCHEDULING MUST BE MADE PRIORTO 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUB.f <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEF <br /> MANIFEST# <br /> j TRANSPORTER COPY <br />