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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Q 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> ` GENERATOR WASTE ACCEPTANCE N0. <br /> Pacific elm t&EkN-t ric <br /> MAILING ADDRESS <br /> 77 e 5`t t;Ami Sing M4A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sang ` D'`A X4120 <br /> Q GLOVES Q GOGGLES U RESPIRATOR Q HARD HAT <br /> t PHONE <br /> Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> R Gmy SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> .JP, 1/) <br /> 1w: � <br /> l <br /> GENERATOR'S CERTIFICATION:I hereb ify that the above named material is not a hazardous <br /> waste asdefinetl by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> descrebed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> ' ' 'regulations;ANP,If the waste Is a treatment residue of a previously rested hazardous waste <br /> osal <br /> 3u to the land DispRestrictions;I certify and warrant that the wasterhas been treated in RECEIVING FACILITYaccordance with the requirements of 40 CFR Part 268.and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261_ <br /> WASTE TYPE: <br /> ISPOSAL _ Q SLUDGE <br /> ❑'CONSTRUCTION Q WOOD <br /> UD B is Q OTHEP <br /> R SPECIAL WASTE <br /> GENERATING FACILIT <br /> ...... �i?e .yskor Sian <br /> ,..> I.4TITA0P <br /> NSPORTER NOTESy "VEHICLE LICENSE ER ' TRUCK NUMBER <br /> - <br /> DPRESS' <br /> Bente C3our: <br /> CITY>STATE,ZIP t <br /> M1 <br /> A 95492 <br /> PHONE` END DUMP BOTTOM DUMP TRANSFER <br /> f` "707)833-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS.. <br /> ❑ ❑ ❑ <br /> A k}a <br /> r <br /> -� CUBIC YARDS <br /> 1 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 <br /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS' <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> � 1 <br /> Q ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GFINFRATOR COPY MANIFEST u 7 Q Q c:n A <br />