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rCanyon ❑ OX Mountain T ❑ Newby Is nd ® Forward Y <br /> -.A: ;,,' nitary Landfill itary Landfill SanitarvWndfill Landfill <br /> _ 901 Bailey Road it,0 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> u r' Phone (925)458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone(209) 982-4298 <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 /> `-' 234 <br /> 8709 N. DAVis: Rd. <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> StocKton, CA UO2UU PHONE ❑GLOVES O GOGGLES U RESPIRATOR aHARD HAT <br /> (209)478-1614 a TY-VEK U OTHER <br /> CONTACT PERSON <br /> Ed Niemalln SPECIAL HANDLING PROCEDURES: <br /> SIGNAT E O AUTHORIZED AGENT/TITLE DATE <br /> r <br /> �k / 2/1/00 none <br /> GENERAT R's CERTIFICATIOI herebykortify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part t or titla 22 of the California code o1 regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste is a vestment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Rastrichons,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 Pail 261. Forward Landfill <br /> WA E TYPE: <br /> ISPOSAL U SLUDGE 9999 S• Austin Rd. <br /> ❑CONSTRUCTION ❑WOOD Manteca, CA 95336 <br /> ❑DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> Borth Stockton Auto Service <br /> NAME NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim Thorpe <br /> ADDRESS c <br /> a <br /> CITY, STATE,ZIP <br /> Lodi , 5 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 13 ❑ ❑ <br /> SIGNATUR OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 12/1/00 <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 /> REMARKS ❑ SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ASBESTOS <br /> ❑WOOD f <br /> J <br /> U ASH <br /> `J SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.TH9 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 /> MANIFEST# <br /> GENERATOR COPY <br />