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KellaranyQn ❑ Ox Mountain El Newby IslandForward <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 /> [GEN;ERATOR WASTE ACCEPTANCE NO. <br /> acific Cas& Etcctric <br /> G ADDRESS Agon <br /> _ <br /> 7 Beale yMailCode `11ri/7 <br /> TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fra iiac CA 941')A U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTAUT155FISOTT <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATUR OF AUTHORIZED AGENT/TITLE DATE <br /> A#N,..d Agaid for <br /> i v'61ne <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is rat a hazardou <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> Wgulations;AND,If the waste is a treatment residue of a previously restricted hazardous 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 /> U ONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> I nc nitonhyuraior ntxni.on <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DCEIBCOC lranspoxtatlan r� <br /> ADDRESS <br /> _R70 II)_en ante. _ <br /> CITY,STATE,ZIP <br /> ry <br /> A 9IS492 <br /> PHONE END DUMP BOTTOM DUMP TRANSF <br /> SIGNATURE OF AUTAM14EP AGEYT DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DIRIARAQ <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 <br /> U SOIL <br /> REMARKS , k <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER' DEBRIS <br /> ❑NON-FRIABLE <br /> IGNATURE OF AUTHORIZED'AGENT DATE ASBESTOS <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <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 /►RRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST M K(1 l C1 7 1 <br />