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I I nCfifC► .�.a 1y91 11 u UX IVIUMILanl u ivewuy Isiana i rorwara <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 /> 0NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> .L r I. r..:., <br /> acl�.c ��'a.:. ��. E,�ti1�,� <br /> MAILING ADDRESS <br /> A"or) <br /> 77 Be,& 5trflot L �1ait Code;B24 Ir.:. <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> `man Fran�.Iyr.oy CA 941 2-0- <br /> PHONE ❑GLOVES ❑GOGGLES D RESPIRATOR ❑HARD HAT <br /> - 5 97;-_3773 ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Robert GTa-r SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> / 1 � .�� Dalt lonze tlgenl for <br /> Pacific Gal <br /> &flectric J , <br /> wr_ <br /> f`it}dit', <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> de9crtbed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,d the waste Is a treatment residue of a previously restricted hazardous waste <br /> suNed to the Land Disposal Restrictions,I certify and warrant Ilial the waste has been treated in RECEIVING FACILITY <br /> 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 /> DISPOSAL O SLUDGE <br /> Ib ISONSTRUCTION ❑WOOD <br /> O DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1 L1UIIlUJi1!.f(:fl}'Uii31t7I' 1I1t7II1trJI1 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1enbeste, t ramportatton / <br /> ADDRESS <br /> CITY, STATE,ZIP �. <br /> Windsor CA 97=1.92 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)938-1407 <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED A ENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 'DRUMS <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 /> REMARKS ❑SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THEDAY <br /> 6EFORE. <br /> lI6►ud 11n-. A 1 0'7f) <br />