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] Kellerlli ❑ Ox Mountain ElNewby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill 0liit <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road I II€If0 l <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 l <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 I - <br /> F- '925)458-9891 Fax (650)726-9183 Fax(408)262-2871 Fax(209)982-1009 I <br /> I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> I acifiC Eivvteic <br /> &ING ADDRESS j <br /> A nnn <br /> 77 Reale Street M4 Code — l <br /> �r�va <br /> I-Y,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT i <br /> Pan Franciszrn ( A 94170 <br /> ZONE 0 GLOVES U GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> 0 TY-VEK ❑OTHER S <br /> )N O ! <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NAT F AUTH9@IZED AGENT/TITLE DATE <br /> AWxwi;zcd Agcad for <br /> �) Pacific Cres fir. Cclric !/ / rl ............... <br /> l� 1f <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1 V Ullr <br /> tste as defined by 40 CFR Part 261 or title 22 of ft California code of regulations,has been properly <br /> rscribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> =gulelions;AND,If the waste Is a treatment residue of a prevlousty restricted hazardous waste <br /> l the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY ! <br /> .'dance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> #S E TYPE: <br /> tf It,l1I <br /> DISPOSAL O SLUDGE <br /> O CONSTRUCTION a WOOD <br /> O DEBRIS CIOTHER <br /> ❑SPECIAL WASTE <br /> :NERATING FACILITY <br /> ion rjunydralor ftunuon f <br /> fi <br /> A. RTEIR NOTES: VEHI LE LICENSE NUMBER TRUCK NUMBER <br /> LkmBeste ranstStion <br /> IDRESS P01 <br /> 82,170_ este. _t_ { <br /> rY,STATE,ZIP ` <br /> , CA 9549214�. 1 <br /> IONE END DUMP BOTTOM DUMP TRANSFER I (tool <br /> aN <br /> AUTHOAGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D UMS <br /> 1 <br /> ❑ ❑ ❑ ❑ <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 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER 112+' 1 <br /> ,MARKS ❑SOIL <br /> 0 CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS z, <br /> 'NAT'IRE OF AUTHORIZED AGENT DATE I <br /> — OWOOD { ., <br /> I . <br /> ❑ASH <br /> O SPECIAL OTHER ' <br /> MUNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY 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. ` ti) <br /> GENERATOR COPY MANIFEST tic 1A 1 g 9 1 I <br />