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❑ Keller Canyon ❑ Ox Mountain ❑ Newby lsland 0 Forward <br /> Sanitary Landfill litary Landfill Sanitary ndfill Landfill <br /> 901 Bailey Road 12310 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 /> 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 ST SER`JICES WASTE ACCEPTANCE NO. <br /> MAILINGADDRESS 29a1 `( vy Drive _ -7 <br /> CITY, STATE,ZIP Stnickton , CA 95206 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES 0 GOGGLES ❑ RESPIRATOR aHARD HAT <br /> PHONE Ian <br /> J TY-VEK :)OTHER <br /> CONTACT PERSON John , 1 ennour <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE JDATE <br /> , 11 <br /> Con rac-tor ���?��� None <br /> GENERATOA'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording 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 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 /> WASTE TYPE: <br /> ❑DISPOSAL O SLUDGE 9999 S• Austin Rd. <br /> Z1 CONSTRUCTION OWOOD Manteca, CA 95336 <br /> ❑DEBRIS YW OTHER <br /> a SPECIAL WASTE _ 1 -1(,,00 r h H fib ralass fuel tanq <br /> GENERATING FACILITY <br /> 3505 Navv Drive , Stockton CA 95206 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim Thr ,'1 ' I Tr <br /> ADDRESS - <br /> oX Joi <br /> CITY, STATE, ZIP <br /> Lodi, CA 95241-0357 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 _J ❑ ❑ <br /> SIGNATI�RE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> UBIC YARDS <br /> i <br /> I hereby certify that the above named material has been <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 /> J SOIL <br /> REMARKS <br /> :I CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> �D NON-FRIABLE <br /> - ASBESTOS <br /> SIGNATUR OFAUTH091ZEDAGENT DATE <br /> J W000 <br /> _1 ASH <br /> In SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 COP`% MANIFEST# 170"' 9 7 4 <br />