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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> "71. Sanitary Landfill Sanitary Landfill Sanitary Landfill ` Landfill <br /> W.Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pi-ftburg 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 /> t' Fax, 25)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 /> ?acific Gps&Flag <br /> MAILING ADDRESS: <br /> 77 Be_:3r 1Anfl&DP B24A 4314 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 8m FmEC7ECo`CA941l7 <br /> PHONE. , U GLOVES U GOGGLES U RESPIRATOR O HARD HAT <br /> (415)973-37%3 Q TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robext <br /> SIGNATURE OF AUTHO IZED AGENT/TITLE DATE ma41x)o 4 <br /> kit GENERATOR'S CERTIFICATION:I her rtify that the above named material is not a hazardous <br /> - '� waste as defined by 40 CFR Part 261 orV6 22 of the California code of regulations,has been property <br /> tk 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"j'ihe waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> - 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> ❑CONSTRUCT OD <br /> U DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY _ <br /> Iathtop Ddxydrator S s z x Lr1TI1 C;F <br /> s , <br /> RAN8PORTER NOTES: VEHICLE LICENSE NUMBER TRUOiZ`I4t)MBER <br /> DenP <br /> ADDRESS <br /> ?- 8-0 D=BesIe Cocci - ------ - <br /> CITY,STATE,ZIP - jy jam, <br /> Wi ,CA9549? <br /> PHONE _ END QjJMP BOTTOM DUMP TRANSFER <br /> (70 8384407 ❑ ❑ <br /> SIGNATURE OF AUTHIORIZW AGENT OR DRIVER DATE ROLL=OFFS) FLAT-BED VAN DRUMS <br /> l � <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: (TOSE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER OMNI <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 7 Q CIC 0 0 <br />