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] Keller Canyon F1 Ox Mountain ❑ Newby Island IvForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill r > t <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road ; lIfkI <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 /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 t <br /> .I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :Nt..ATOR WASTE ACCEPTANCE NO. <br /> i�aGiuu �a8 lis. �'��wuaG <br /> ULING ADDRESS <br /> Ai <br /> 77 Beale Street � It_7 7 <br /> 1Y, STATE,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Cin Nran_r_.iac_.o C.A 94.170 <br /> IONE O GLOVES U GOGGLES U RESPIRATOR U HARD HAT { <br /> -- U TY-VEK U OTHERRobert Um _Iti <br /> )N O SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Auffier;mcl Agcrl for 1 1 <br /> Pacific Gm&E1tiea;c <br /> �T��fr• <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous j <br /> isle as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly I , <br /> scribed,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 /> 03 <br /> jec.•t10 the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ;cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> kSTE TYPE: I ; <br /> U DISPOSAL O SLUDGE1 <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS O OTHER i. <br /> U SPECIAL WASTE <br /> :NERATING FACILITY <br /> AdIllikundt r,-chytirAor Thu itm I <br /> IAIJ ORTER NOTESJVEHICLE LICENSE NUMBER TRUCK NUMBER <br /> este' ransportation <br /> IDRESS { <br /> i <br /> rY, STATE,ZIP <br /> bMt}I <br /> IONE END DUMP BOTTOM DUMP TRANSFER `, Q f 1;; <br /> (707)838-1 An7 <br /> 3N RIZED AGENT OR DRIVER DATE ROLL OFF(S) FLAT-BE❑D VAN DRUMS ` <br /> ❑ ❑ ❑ ❑ ' <br /> "'2_ " oe4 <br /> is <br /> CUBIC YARDS 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 dun <br /> U SOIL <br /> ,MARKS <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> aNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> U ASH I� <br /> U SPECIAL OTHER I <br /> )ULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT t{ ) <br /> :FUSAL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST M 341913 <br />