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] Kellner Canyon ❑ Ox Mountain ❑ Newby IslandForward 1 <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill andfill ; <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road 0111101 <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 1 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 I <br /> Fay(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> NEnATOR a �� ^+ WASTE ACCEPTANCE NO. r <br /> 1 adurk, VMS UG L.l4 V AtMi4 <br /> 41LING ADDRESS <br /> 77 Beale.Street � <br /> TY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> fan l+eanri�c� (~F1 �)¢1?.O <br /> LONE ❑GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> --O 0 TY-VEK ❑OTHER I <br /> �N j <br /> SPECIAL HANDLING PROCEDURES: <br /> GNATU OF AUTHORIZED AGENT/TITLE )ATE j <br /> a"ized Agent for —7 i <br /> /Pacific,Gss 4 E1ectx:c <br /> i1quile <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named matenal is not a hazardous 4�1 <br /> asle as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly I <br /> ascribed,classified and packaged,and is in proper condition for transportation a-cording to applicable 1I <br /> rgulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> jbject 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 /> 3 CFR Part 261. <br /> ASTE TYPE: ' <br /> Al"DISPOSAL ❑SLUDGE j <br /> ❑ ONSTRUCTION ❑WOOD I <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> NERATING FACILITY <br /> rnton Dichyclrator Tho';nivn <br /> IAt.6PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 00nt3este transportation / ZQ <br /> MESS <br /> ft! _PSfF ` <br /> TY,STATE,ZIP 95492__ <br /> LONE END DUMP BOTTOM DUMP TRANSFER <br /> (17l -1 A07 ❑ ❑ <br /> 3NATURUF A THORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 'DRUMS <br /> CUBIC YARDS <br /> 1 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) i <br /> is true and accurate. f <br /> DISPOSE OTHER II1tIl <br /> :MARKS <br /> C3 SOIL <br /> ❑CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> 3NATURE OF AUTHORIZED AGENT DATE ASBESTOS ( , <br /> ❑WOOD <br /> U ASH i <br /> O SPECIAL OTHER <br /> PULING MUST BE MADE PRIOR.TO 3:00 P..M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT f I 1 <br /> 000AL,UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY.V FORE 1 <br /> GENERATOR COPY MANIFEST N 341 q rte+ j <br />