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fnyon ❑ OX Mountain ❑ Newby Island ] Forward <br /> t yy Landfill S tary Landfill Sanitary a dfill Landfill <br /> I' +8 Road 12 San Mateo Road 1601 Dixon La-Ming Road 9999 S.Austin Road <br /> Milpitas,CA 95035 <br /> a,CA 95336 <br /> T y ane 925)58--9800 Phone(650) 26-1819 9,CA 94565 Half Moon Bay, CA 19 Phone (4 8) 945 2800 Phone(2 9)982-4298 <br /> tin? a <br /> t == x(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 /> or oc 1+an uto erv�ce <br /> MAILING ADDRESS _ <br /> 8709 N. Davis Rd. 234 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stokton , CA 95209 D GLOVES D GOGGLES 0 RESPIRATOR (HARD HAT <br /> PHONE <br /> _ D TY-VEK ❑OTHER <br /> C014TACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Ed Niemann <br /> SIGNATURE PF AUTHORIZED AGENT/TITLE DATE <br /> 4* i9 1 00 <br /> GENERATOR'S CERTMCATIOW I hereb erhfy that the above named material is not a hazardous <br /> waste as defined by 40 GFR Part 261 or Ve 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 treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. Forward Landfill <br /> WA E TYPE: 9999 S. Austin Rd. <br /> d'DISPOSAL D SLUDGE ,ani eC a, CA 9b336 <br /> O CONSTRUCTION D WOOD <br /> D DEBRIS D OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> North Stockton Auto ServiKe <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim Thorpe Oil , Inc. <br /> ADDRESS 7 <br /> P.O. B02j 357 <br /> CITY, STATE, ZIP <br /> todl, CA 93241-0337 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> -6 a 13 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 1.2/1/00 <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 /> D SOIL ,,,�. <br /> REMARKS •• <br /> ❑CONSTRUCTION t <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br /> D WOOD <br /> 0 ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAL"F ECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> GENERATOR 0OPY MANIFEST# <br />