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j Keller Canyon , a F-1OxMountain E] Newby Island ( Forward <br /> Sar"itary, '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 I <br /> FAY(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 i <br /> NON-HAZARDOUS WASTE MANIFEST j <br /> i <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> Pacific Oras&E'Acctnic <br /> ►ILING ADDRESS i <br /> 77 Reale Street � ��7— <br /> rY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> IO San Franr_.iwet CA 94170 O GLOVES ❑GOGGLES O RESPIRATOR U HARD HAT I <br /> tFlFal <br /> (415) 9-73-3723 <br /> ❑TY-VEK ❑OTHERI �! <br /> INTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> aNATU E OF AOTHORIZED AGENT/TITLE DATE <br /> rriz«f Agent for <br /> 'kpcific Cees 4 Electric <br /> -NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> We as defined by 40 CFR Part 261 or filte 22 of the California code of regulations,has been property <br /> ascribed,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> gulations;AND,If the waste Is a treatmeM residue of a previousty restricted hazerdous waste <br /> ibject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cardance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> i CFR Part 261. <br /> i <br /> WE TYPE: !t IN <br /> DISPOSAL O SLUDGE <br /> ❑ ONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER l <br /> ❑SPECIAL WASTE I <br /> INERATING FACILITY ! <br /> . iuttTiahycisatc�r ihc�rnic��a � W <br /> Kill, RTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> exWeste Tans�c�rta>ra>Ta <br /> (DRESS <br /> M STATE,ZIP <br /> Win"n, CA 95492 ilflFltb <br /> IONE END DUMP BOTTOM DUMP TRANSFER <br /> -1 407 ❑ ❑ <br /> -NA_rUF <br /> AOF AUTHORIZED AGENT OR DRIVER DATE OIL-OFF(S) FLAT-BED VAN XDRUMS <br /> ` ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> iccepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER b t <br /> R'R% <br /> O SOIL <br /> MARKS <br /> ❑CONSTRUCTION <br /> CIUTY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> !NATURE OF AUTHORIZED AGENT DATE ! <br /> ❑WOOD I <br /> ❑ASH <br /> ❑SPECIAL OTHER J <br /> )WILING MUST BE MADE PRIOR TO 3:00 P.M.TNE-DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT � bit-of <br /> FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. 11t1 <br /> GENERATOR COPY MANIFEST# 341989 <br />