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] Keller Canyon ❑ Ox Mountain ❑ Newby Island 1`1'Forward <br /> Sanitary,Landf 11 Sanitary Landfill Sanitary Landfill Landfill <br /> 901 D IIey'Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road b' ' <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 /> F- -'925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 i <br /> NON-HAZARDOUS WASTE MANIFEST <br /> I <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> Pack Gas 19X L1V4�M <br /> kILING ADDRESS gCIO0 <br /> 77 Tleale ;tre:et <br /> rY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Fr nri CA 441? 1 I s <br /> IONE 0 GLOVES LI GOGGLES 0 RESPIRATOR 0 HARD HAT it <br /> -- U TY-VEK LI OTHER <br /> )N O SPECIAL HANDLING PROCEDURES: <br /> 3NATU OF AUTHORIZED AGENT/TITLE DATE <br /> % Atrthoriztd Aged for <br /> f I .•: <br /> Pacific Cies&Mectr•ic /�/ , <br /> ZZ �— <br /> ENERATOR'S CERT IF ATION:1 hereby certify that the above named material is not a hazardous None <br /> rite as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property i i <br /> mcribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulabons;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> 4ec.t to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> xordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> >STE TYPE: D O I <br /> DISPOSAL ❑SLUDGE , 1 <br /> O CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY j <br /> tan lhyclratcn I hurnivia <br /> I <br /> PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1 Beate Tra r tion <br /> )DRESS <br /> IY, STATE,ZIP <br /> Wintistair CA 954,92 &tf.�p <br /> IONE END DUMP BOTTOM DUMP TRAVS ER 6#411 <br /> aN _A0r,ORIZED A137ENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DFRUMS - <br /> ❑ ❑ ❑ ❑ <br /> i <br /> CUBIC 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 4vio <br /> MARKS ❑ SOIL <br /> n <br /> 0 CONSTRUCTION <br /> ✓ILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> iNATI IRE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> D ASH "J <br /> O SPECIAL OTHER <br /> IULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT 18 v t Iv <br /> FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THEDAY BEFORE. <br /> GENERATOR COPY MANIFEST M 34.���:6 7 <br />