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] Keller'--Canyon ❑ Ox Mountain ❑ Newby Island Forward j <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Baifey'Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road ; 19 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 /> FaY(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NERAT — �� WASTE ACCEPTANCE NO. <br /> i aCLU%, vasa i<nr�.uii <br /> AILING ADDRESS <br /> A CVC n— <br /> 77 Beale Street Mail Code B24A t 7 V.7 <br /> TY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fr. <br /> nciar.n ('A 9¢170 ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> IONS { <br /> -- -- OTY-VEK ❑OTHER on*( <br /> )N O I <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NAT E OF AUTH RIZED AGENT/TITLE DATE <br /> � �) Attlhorized Agetd Gtr <br /> �- Pacific Gas&Electric <br /> i-Toile <br /> ENERATOR'S CERTIFICATION:I hereby certify Etat the above named material is not a hazardous <br /> aste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> rsoribed,Classified and packaged,and is in proper condition for transportation a-cording to applicable - <br /> gulabons:AND,If the waste is a treatment residue of a prevlousy restricted hazardous waste <br /> tbiecl to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> mrdatce with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> )CFR Part 261. <br /> >STE TYPE: <br /> I !I :! <br /> DISPOSAL U SLUDGE I$Not <br /> •CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY I <br /> r <br /> AL)n[vn lkuydraw' T fhonitull <br /> IAN-.-ORTER NOTES: VE ICLE LICENSE NUMBER TRUCK NUMBER l <br /> 0enbeste l ransportation <br /> IDRESS l� I <br /> _ <br /> IY,STATE,ZIP , <br /> CA 95492 t <br /> IONE END DUMP BOTTOM DUMP TRANSFER (#910? <br /> (7m)m_1407 > i ❑ ❑ <br /> 3NATURE OF AUT ED ENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> 1 <br /> DISPOSE OTHER #l11 <br /> U SOIL <br /> :MARKS �• . <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS ' <br /> U NON-FRIABLE <br /> ASBESTOS 1 <br /> 'NATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH } <br /> U SPECIAL OTHER <br /> l <br /> 3ULING,MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> FU$AL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. i lt�l�d <br /> GENERATOR COPY MANIFEST# 342001 <br />