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j KellwPanyop ❑ Ox Mountain E] Newby Island 'Forward <br /> id <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road i <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 I <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> It;�Cl1 <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> 1 RV111V %'Jaa tic J.i1VVW.1V <br /> ULING ADDRESS _ <br /> 77 Reale Street Mail Code B94A _t.7 V 7 <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Frartr_.i_.acD �'A 94179_ <br /> PONE U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> U TY-VEK U OTHER <br /> )INTACT PERSON I <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> J / Atithorved Agcsd for j <br /> I acific Ciao&Fl"kri�fc "- / ............... _ <br /> i <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1r V�tL <br /> late as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property i <br /> rscribed,classified and packaged,and is in proper condition for transportation a-cording to applicable I <br /> gulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> deject 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 Pan 266 and is no longer a hazardous waste as defined by <br /> i CFR Part 261. =I <br /> %STE TYPE: <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> NERATING FACILITY <br /> Thornuon 13iehydraim Uhurntoti <br /> I I <br /> IAI ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER I <br /> enl3este 1•rans rtahon '�+ � <br /> ►DRESS �✓ �C� <br /> 820 eat€- _.t. <br /> IY,STATE,ZIP <br /> Windsor CA 95492 <br /> IONE END DUMP BOTTOM DUMP TRANSFER I <br /> 9th _ ❑ ❑ <br /> 3NA UR HOFflZFD AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> /1.21a <br /> CUBIC YARDS l � <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. I <br /> DISPOSE OTHER <br /> :MARKS U SOIL 1 <br /> U CONSTRUCTION <br /> CILI.TY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> 3NATURE OF AUTHORIZED AGENT DATE ASBESTOS 4 y• # <br /> U WOOD .1 <br /> U ASH <br /> O SPECIAL OTHER <br /> PULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED.WITH THE,LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST 11_3..41 9 8 6 <br />