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❑ Keller Canyon . ❑ Ox Mountain ❑ Newby IslandX 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 <br /> J_ NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> pacific Oa., & 0cc"ric <br /> MAILING ADDRESS ��� <br /> 77 e t Mail Code B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> FPHONE <br /> aE!Francis�4a CA 94120 ❑GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> ") 97 1— ❑TY-VEK U OTHER <br /> CT ERSONost�. SPECIAL HANDLING PROCEDURES: <br /> URE OFA THORIZE AGENT/TITLE JbATE <br /> tr Atllltpttized Agent for <br /> P i c Cs&Electric /r r <br /> � M <br /> i�ut�rC <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,Classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> Subject to the lard Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> acoordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE: <br /> ISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> norniun i-Mnycirauyr i nomion <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> eAc ransportation � <br /> ADDRESS 4 <br /> CITY,STATE,ZIP <br /> Windsor., CA 93492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707183:9-1407 ❑ <br /> SIGNATURE OF AUTFJPRIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT BED VAN DRUMS <br /> w ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <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 <br /> EMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> f <br /> U WOOD <br /> ❑ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENFRATOR COPY MANIFEST# 4 4/ n i!f <br />