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] Keller Canyon ❑ Ox Mountain ❑ Newby IslandPlandfill <br /> orward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ; I <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> ; stool <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 1 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax (209)982-1009 ' <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NEI-IATOR WASTE ACCEPTANCE NO. <br /> I aci#Zc Cas & Fkctdc <br /> ULING ADDRESS <br /> 77 Beale Strcet Mail Code B24A <br /> i.7V7 <br /> rY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> SanFr nciccn C`A 9417.1) Q GLOVES Q GOGGLES U RESPIRATOR U HARD HAT' <br /> IONE <br /> U TY-VEK U OTHER 16661 <br /> )N O SPECIAL HANDLING PROCEDURES: <br /> Robed Or-mr <br /> 3NATURIE OF AUTHORIZED AGENT/TITLE DATE <br /> 1 Authutized Algcmt for / <br /> Pacific Cm be Mect is � <br /> ;`�tTBiie <br /> ENERATOR'S CERTIFICATI :I hereby certify that the above named material is not a hazardous <br /> este as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> rscribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste 1 <br /> Object to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> eoord0rice with the requirements 0140 CFR Part 266 and is no longer a hazardous waste as defined by i. <br /> I CFR Pan 261. <br /> kST.E TYPE: <br /> O DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION ❑WOODS <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE I w <br /> :NERATING FACILITY <br /> -hmpion rmhydrakn 'Thomiert <br /> ;At 7RTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> � ,i este T ramportation I <br /> ,DRESS <br /> _X70 _lenRiwil._ .f <br /> I <br /> rY, STATE,ZIP <br /> WiniLgor, CA 9i492 #g:oj <br /> IONE END DUMP BOTTOM DUMP TRANSFER I tool <br /> ❑ ❑ <br /> iN -A RIZED Aj21ENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 I kl <br /> MARKS o SOIL <br /> ❑CONSTRUCTION <br /> rMLITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE ; <br /> 0 WOOD <br /> ❑ASH f <br /> I <br /> U SPECIAL OTHER <br /> HIUIVG MIDST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT ei <br /> ,FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. .a.oil <br /> 'j <br /> GENERATOR COPY MANIFEST N 341915 <br />