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Keller Canyon F1 Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill AUDI <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road I#it IIF A <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 /> F- '925)458-9891 Fax (650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> C <br /> :NERATOR WASTE ACCEPTANCE NO. II' <br /> Pacific las &Ltcc 'c 1 <br /> ,ILING ADDRESS <br /> >— <br /> 77 Beale, sti-�.�t s> � <br /> iY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francilar_.n CA 94170 O GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT ) It <br /> ONE <br /> Q TY-VEK Q OTHER l o o p$ <br /> IN O SPECIAL HANDLING PROCEDURES: <br /> aNATURE OFA1qHORIZED AGENT/TITLE DATE <br /> Au&m i=d Racat for j <br /> Ppcific(has&Electric j� � ............... <br /> ., -- <br /> :NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1rU��e <br /> este as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> scribed,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> - <br /> Iulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> Macs to the Land Disposal Restrictions,1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> oordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR Part 261. <br /> ISTE TYPE: ! p I <br /> DISPOSAL O SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> O DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> NERATING FACILITY I <br /> micm Duhydmtur i holitto-.1 i �- <br /> � I i <br /> ANSrORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L)efib(:8th on 4�1 f _F <br /> DRESS92.0 I <br /> _�_ <br /> Y, STATE,ZIP <br /> WtndS CA tt,it'i t <br /> ONE END DUMP BOTTOM DUMP TRANSFER 0.oto <br /> i ❑ ❑ <br /> .NATURE A D AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DPKJMS <br /> .— ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I <br /> hereby certify that the above named material has been } �? <br /> tccepted 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 q6 <br /> Q SOIL y <br /> MARKS <br /> .I. O CONSTRUCTION <br /> �ILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> iNATt IRE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> 1 <br /> IULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT ! f A <br /> FUSAL,UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. btPAll <br /> GENERATOR COPY MANIFEST# 'A d 1 9 C;q <br />