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F] Keller Canyon F1Ox Mountain ElNewby Island Forward <br /> "1 Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> s 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 /> s Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> e _ Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> . NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE'N0. <br /> ;. Pacifiz Gas-k,1a kelic <br /> MAILING ADDRESS <br /> 77 DeMe Sireet.l siF B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> co,CA 94120 0 GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> (413} 73.3773 0 TY-VEK 0 OTHER <br /> CONTACT PERSON SPEC AL HANDLING PROCEDURES: <br /> Reed <br /> SIGNATURE OF AUTHORIZ AGENT/TITLE DATE V <br /> GENERATOR'S CERTIFICATIONA hereby fedk that the above narned material is not a hazardous - <br /> f waste as defined by 40 CFR Pail 261 or fille i the California code of regulations,has been properly <br /> r 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 Pad 261. - <br /> _- WASTE TYPE: <br /> 'DISPOSAL <br /> <br /> <br /> <br /> <br /> <br /> RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 3 �8�a1 Tr i �rixt�ca3 --- eQ <br /> - <br /> ADDRESS <br /> 820 D>nB�este;0.4m — -- <br /> CITY,-STATE,ZIP - � a <br /> Win&wCA015492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> QQT)838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> * r� <br /> V)'C—A <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to'the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> 0 CONSTRUCTION .� <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE •� <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE •� <br /> O WOOD <br /> O ASH •� <br /> O SPECIAL OTHER •� <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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# n n n n n-7 <br />