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Keller y, :..; ❑ Ox Mountain ❑ Newby Island 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 /> :NERATOR WASTE ACCEPTANCE NO. I <br /> racnic Gas& 1'l"tric <br /> TILING ADDRESS <br /> 77 Reale Street <br /> Mail Code B24 A <br /> fY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sin Ft TIEi!un CA 941 20 0 GLOVES U GOGGLES 0 RESPIRATOR U HARD HAT <br /> ONE <br /> (415) 973-3-773 U TY-VEK U OTHER <br /> INT CT PERSON SPECIAL HANDLING PROCEDURES: `f <br /> I <br /> aNATURE OF ALTTHOFJIZED AGENT/TITLE DATE <br /> Awhm ized Agrat for <br /> PricifIc Gas&Electric .............. <br /> s�us�e <br /> '1JERATOR'S CERTIFICATION:I hereby certify that the above Warned material is not a hazardous <br /> tste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> pulations;AND,It the waste Is a treatment residue of a previously restricted haxerdous waste <br /> bject to the land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by i- <br /> CFR Part 261. i <br /> kST,E TYPE: - <br /> bISPOSAL O SLUDGE <br /> ONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> :NERATING FACILITY <br /> TnUrniml 1-mityuralur I nomton ! 'i <br /> IA-48PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> asC <br /> LlIe <br /> nl3este l'ransportation 6 y <br /> ,DRESS <br /> 820 €'sle. Ct. <br /> rY,STATE,ZIP <br /> Windsor, CA 95492 <br /> ,)NE END DUMP BOTTOM DUMP TRAN R <br /> "- A07 ❑ i <br /> aNA UR F AgjkKVZED nPENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DIRUMS <br /> ❑ ❑ ❑ ❑ <br /> t It ft tl <br /> CUBIC YARDS <br /> i <br /> 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. t <br /> DISPOSE OTHER <br /> U SOIL <br /> :MARKS _ <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> 3NATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> o WOOD <br /> U ASH <br /> U SPECIAL OTHER { <br /> DULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT I , <br /> 4FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> r:FNIPRATnR MPY MANIFEST N 3 419 8 8 I <br />