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❑ Keller Caon ❑ Ox Mountain ❑ Newby Island [Forward <br /> SanitaSanitary 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 /> r <br /> GENERATOR WASTE ACCEPTANCE NO. t <br /> !"acific <br /> MAILING ADDRESS <br /> �va_ <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> •n Franc.isqco, CA 94120 0 U GLOVES U GOGGLES U RESPIRATOR O HARD HAT I <br /> PHONE <br /> -- U TY-VEK U OTHER <br /> CONT R O <br /> SPECIAL HANDLING PROCEDURES: � <br /> SIGNAT,li OF AUTH IZED AGENT/TITLE DATE <br /> Audw ized Agent for / <br /> acific is /4 <br /> Gas&Ele ................ I C <br /> i <br /> wr_ <br /> GENERATOR's CERTIFIC TION:I hereby certify that the above named material is not a hazar s <br /> waste as defined by 40 CFR Part 261 or title 22 of the Califomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> reg�ations-AND,H the waste Is a treatment residue of a previously restricted haxerdous waste <br /> subject to the land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance 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 /> DISPOSAL U SLUDGE <br /> CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> Thmnion Bichydrdiur 111crrniuft <br /> .,..ANS I PORTER NOTES: VEICLE LICENSE NUMBER TRUCK NUMBER <br /> 1)e este-1-ramportation. % 1 <br /> ADDRESS Yffi <br /> _ _ art etat� .t <br /> CITY,STATE,ZIP <br /> AMndsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> R-AR-IA07 ❑ ❑ Wr , <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D UMS <br /> t <br /> CUBIC YARDS <br /> hereby certify that the above named material has been i <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 /> O <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE + <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD Ib <br /> I <br /> U ASH <br /> ❑SPECIAL OTHER <br /> CHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. f <br /> ncwcanrrUQ ntvw MANIFEST M 34196 6 <br />