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] Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill . Zandfill fits O <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road Ili 6 It <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 /> I <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> 1 ft4ltiV VQJ lC, l_r�slr lv <br /> ULING ADDRESS <br /> 77 Beale Street Mail Code B24Aova— <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Frannicc rz C.A 9417f) <br /> ]ONE O GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> U TY-VEK U OTHER I Q <br /> >N iVCW MOAN <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE j <br /> �� n k AjAmized Agent for I <br /> Pacific Gm&Electric /( <br /> 1�TiJ�ir <br /> cNERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> tste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> scribed,classified and packaged,and is in proper condition for transportation a cording to applicable ! <br /> gulf ions;AND,If the waste Is a treatment residue of a previously restricted hazardous waste It <br /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY l <br /> aordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> \STE TYPE: . <br /> O DISPOSAL U SLUDGE f4 it it r <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> :NERATiNG FACILITY <br /> ion 1)1Uny&dt1Ur I huntion <br /> A,.PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> l.knHeste1ransportaUon <br /> DRESS <br /> _ _ _extte .t <br /> rY,STATE,ZIP Wind.gar, CA 95492 leo <br /> 'O E END DUMP BOTTOM DUMP TRANSFER 4 01i1 <br /> ❑ ❑ <br /> nN AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DMUMS <br /> CUBIC YARDS <br /> I.her b certify that the above named material has been <br /> Cce t 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 I ( <br /> MARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> ;.ILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD I <br /> O ASH .� <br /> 0 SPECIAL OTHER f <br /> )UUNG MUST BE MADE PRIORTO 300 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST tt -14 1 q q <br />