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] Keller Canyon ❑ Ox Mountain ❑ Newby Island ((Forward i <br /> Sanitary LAndfill Sanitary Landfill Sanitary Landfill Landfill w <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 /> nnu <br /> :NERATOR WASTE ACCEPTANCE NO. a ' <br /> 1 CLlillAV ^J U? (JC. 1_A.1v%,lJ.14 <br /> kILING ADDRESS <br /> 77 Beale `street Maill Ccidc B24A190 — <br /> fY,STATE,ZIP <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francl4;c o CA 94120 ❑GLOVES ❑GOGGLES O RESPIRATOR o HARD HAT j <br /> IONE <br /> vIf <br /> - L)TY VEK 0 OTHER <br /> )INTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> I <br /> 3NA E OF ALJTHOR17,ED AGENT/TITLE DATE <br /> % ,"sized Agent fix <br /> itic CT"&Electric <br /> I <br /> ENERATOR'S CERTIFICATION:t hereby certify that the above named material is not a hazardous 1�ItJill' <br /> este as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> rscribed,Classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,If the waste Is a bvetment residue of a previously restricted hazardous waste <br /> kited to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> kST,E TYPE: <br /> � J <br /> V(P <br /> ISPOSAL U SLUDGE <br /> ONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> r,, <br /> tnumion innyuraivr t.rtvmic)tt <br /> A,.,.,PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER `a' I <br /> L)eftlldesU 11 ransportation <br /> (DRESS 7 c <br /> _ en tste t <br /> FY,STATE,ZIP <br /> — I <br /> WindsOL CA 95 i <br /> IONE END DUMP BOTTOM DUMP TRANSFER <br /> D R-AR"t 7 ❑ ❑ ❑ <br /> 3NATURE OF AUT T OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> Dual; <br /> CUBIC YARDS t <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 I <br /> :MARKS O SOIL <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> 3NATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ❑WOOD t <br /> i <br /> U ASH <br /> I <br /> U SPECIAL OTHER <br /> x1UNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED.ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED-WITH THE LANDFILL THE DAY B <br /> EFORE. <br /> GENERATOR COP <br /> Y MANIFEST N141994 <br />