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Keller Canyon ❑ Ox Mountain E] 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 I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> �IIt#I <br /> _NERATORIt< t <br /> Pac;�c Gas feu WASTE ACCEPTANCE N0. <br /> AILING ADDRESS I <br /> A(inn— <br /> 77 Beale Street Kiali Co&B24A <br /> rY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San FparZr_.igco ('A 94120 ❑GLOVES ❑GOGGLES LI RESPIRATOR ❑HARD HAT <br /> IONE <br /> (4151971-3771 U TY-VEK O OTHER t <br /> )INTACT PERSON <br /> SPECIAL HANDLING PROCEDURES:RobeA am, <br /> ! <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE j <br /> Pacifit•iG Agrut ctr � <br /> � Pacific Gea&Electric l �. . II-il II�JI <br /> ivuu� <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> We as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property i <br /> mcnbed,classified and packaged,and is in proper cond'4ion for transportation a-cording to applicable <br /> gulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> Wct to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY I <br /> xordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by i <br /> I CFR Part 261. <br /> %STE TYPE: <br /> DISPOSAL U SLUDGE <br /> 'U"CONSTRUCTION O WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> I <br /> 1NERATING FACILITY <br /> homion Duhyuraiur T"ROMLUII <br /> IAN ORTER NOTES: VEHICLE LICENSE NUMBER TRUCKNUMB-ER }J�iilI <br /> 1)enrieste lranspottation <br /> )DRESS T <br /> 92-0 cs P_. - <br /> TY,STATE,ZIP <br /> i <br /> Wirtdsar. <br /> CA 9492 <br /> TONE END DUMP BOTTOM DUMP TRAN ER <br /> (707)838-1407 ❑ ❑ "1 <br /> 3 UR OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 'DRUMS <br /> 1 n <br /> JI lila <br /> CUBIC YARDS tP <br /> hereby certify that the above named material has been 1 <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> 9 <br /> DISPOSE OTHER <br /> U <br /> :MARKS SOIL <br /> U CONSTRUCTION <br /> x' <br /> ,CILITY TICKET NUMBER DEBRISU NON`-FRIABLE <br /> ASBESTOS >I <br /> 3NATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> U ASH { J ✓ <br /> U SPECIAL OTHER <br /> DULING MUST BE MADE PRIOR TO 3.00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•tH <br /> UNSCHEDULED LOADS ARE SUBJECT I <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED THE LANDFILL THE DAY BEFORE. I <br /> GENERATOR COPY MANIFEST# 341990 i <br />