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] Keller Canyon ❑ Ox Mountain ❑ Newby Island �j Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 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 /> 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 <br /> I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NEOR <br /> n :-r <br /> l� WASTE ACCEPTANCE NO. I + <br /> aViJ�14 JaA l7b �1V4i.E 1� <br /> ULING ADDRESS _ <br /> 77 Reale Street Mail Code B74A <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco, CA 94120 �) <br /> ")NE <br /> ❑GLOVES U GOGGLES O RESPIRATOR O HARD HAT <br /> U TY—VEK U OTHER <br /> )INTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Chlay <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Authorized Agent for F <br /> Pacific Chu&Elat•ic <br /> j CILT. <br /> ENERATOR'S CERTI AnON:I hereby certify that the above named material is not a hazardous 1�UQ1� <br /> ksW as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property II <br /> scribed,Classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> pulations.AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> biect to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> I CFR Part 261. <br /> \STE TYPE: <br /> i <br /> 'DISPOSAL O SLUDGE <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER I <br /> U SPECIAL WASTE <br /> :NERATING FACILITY <br /> Thumivn fD-vhyahaiur i nurliioxt �, <br /> At )RTER NOTES`. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Ifoe't <br /> j_)en-este Trans nation j <br /> DRESS / C�} <br /> 920 H.P £ste. --1- r <br /> FN, STATE,ZIP <br /> WincL-qnr. CA 9549-2 <br /> ONE END DUMP BOTTOM DUMP TRANSFER � <br /> (! 1R'i _1 407 ❑ ❑ i s <br /> 3NATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN RUMS <br /> ❑ ❑ ❑ ❑ I <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) t <br /> f <br /> DISPOSE OTHER <br /> U SOIL <br /> MARKS <br /> U CONSTRUCTION <br /> �ILITY TICKET NUMBER DEBRIS <br /> U NON—FRIABLE <br /> ASBESTOS <br /> iNATURE OF AUTHORIZED AGENT DATE <br /> o WOOD <br /> i <br /> U ASH <br /> O SPECIAL OTHER <br /> I <br /> )ULtNG MUST BE MADE PRIORTO 3:00 P.M.THE QAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST N 341928 <br />