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] Keller Canyon ❑ 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 )(€091 <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 /> F-(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax (209)982-1009 <br /> I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> 1�CL1✓lAl�+ i�J—� UL �1V44Ml Au I <br /> ULING ADDRESS <br /> 77 Beale Street — <br /> TY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT j <br /> Sart Franriarn CA 9417.() CLOVES E-GOGGLES O RESPIRATOR trPWRD HAT �b @ <br /> LONE <br /> -- O TY-VEK U OTHER <br /> )N _ 011 � <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE I <br /> uthoniz.ed Agent fiw <br /> ific Gas&Electric <br /> ENERATOR'S CERTIFICATIO .I hereby certify that the above named material is not a hazardous <br /> este as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> rscribed,cassified and Packaged,and is in proper condition for transportation a-cording to applicable <br /> gtdations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> tbiect to the Land Disposal Restrictions.I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> xordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> )CFR Part 261. - <br /> kSTE TYPE: I <br /> ISPOSAL U SLUDGE * , <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER I y <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> .q <br /> A <br /> (on T�hyuraior .1 nurntfm jIAL ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> IDRESnj3e8te ' r 'Wmtlort f <br /> _ _ .n (ate 1171 - <br /> FY,STATE,ZIP <br /> Windgeir, A 9549z 41 Q_111 <br /> IONE END DUMP BOTTOM DUMP TRANSFER <br /> -IN A RIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> CUBIC YARDS j <br /> 1 hgre y certify that the above named material has been j <br /> 3cc6pt d and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER tt '1 <br /> :MARK O SOIL <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> I <br /> _—A <br /> _UE PECIAL OTHER <br /> i1 NG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT tl It I <br /> WSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. n fF1 <br /> GENERATOR COPY MANIFEST# *141 g qn-'S i s <br />