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❑ Keller Canyon ❑ Ox Mountain, ❑ Newby Island X64-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 NO. <br /> Pacific <br /> Y <br /> 1[�V� Gas s (X Elccf is . <br /> MAILING ADDRESS Y,1 <br /> 77 Beale Street Mad CodQ B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> r Sail FsraIlcyco' CA 9105 SPECIAL HANDLING PROCEDURES: <br /> ❑GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> 71' O TY-VEK O OTHER <br /> CONTACT PERSON <br /> Robeil C ' _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I here c rt fy that the above tamed nater al is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or,G 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is.in proper condition for transportation a-cording to applicable <br /> v` <br /> regulations;AND,If the waste is s treatment residue of a prevbuity restricted hazardous waste <br /> Subjedlo the,Land Disposal Restrictions,j certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> y; accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> " 40 CFR Part 261. - <br /> WASTE TYPE: <br /> ISPOSAL ❑SLUDGE <br /> ' CONSTRUCTION O WO <br /> k Q DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> ' GENERATING FACILITY. <br /> t ?4?�IIiQ 5tatln Lat9lTop <br /> rR.,N PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Dent3este Trani _crrtYian <br /> ADDRESS <br /> 820 x,er1 B:s_ <br /> CITY STATE,ZIP <br /> Alindsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 7 " aRn8_ s 7 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> 3 CUBIC YARDS <br /> hereby certify that the above named material has been <br /> y; 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 /> O SOIL <br /> IIEMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> f FACILITY TICKET NUMBER ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> r <br /> ❑WOOD <br /> 0 ASH <br /> O SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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 /> (-r NPPATnR rnPY MANIFEST# 9 CQ i Q Q n <br />