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Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill I <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 I <br /> Phone(925)458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone(209)982-4298 I Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> �IE�I <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> aci c Gas � cctrc I <br /> JLING ADDRESS <br /> �>- <br /> 77 Beale Street Mail Code Ii24t1. <br /> J <br /> FY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sari _rapctsoo, CA - 20 I s <br /> IONE ❑GLOVES ❑GOGGLES U RESPIRATOR O HARD HAT <br /> ti' 91 __ U TY-VEK U OTHER <br /> INTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert QMY <br /> 3NATURE OFAUTHORIZED AGENT/TITLE DATE <br /> j . Atdinxizcd Agent for / I <br /> P c Gaa&Electric <br /> NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> We as defined by 40 CFR Part 261 or fitle 22 of the California code of regulations,has been propedy <br /> scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,If the waste Is a treatment residue of a previously restricted haxerdous waste <br /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY f <br /> oxclance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by 4 <br /> 1 CFA Part 261. <br /> 1ST TYPE: I . <br /> fSPOSAL U SLUDGE I <br /> NSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> :NERATING FACILITY <br /> i homiun Oenydrawr nonlMn <br /> AN. )RTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER r <br /> n.Mste 'ransnortatlon <br /> ,DRESS <br /> _ e: f e. t <br /> FY,STATE,ZIP <br /> Wmdscsr CA 974.92 <br /> IONE _ END DUMP BOTTOM DUMP TRANSFER <br /> 70 838-1407 ❑ ❑ <br /> 3NATURf OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D MS <br /> CUBIC YARDS <br /> he 4y certify that the above named material has been f <br /> aCCe ted 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 /> :MARKS O SOIL I <br /> ❑CONSTRUCTION I <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> NATURE OFAUTHORIZED AGENT DATE " <br /> O WOOD <br /> ❑ASH L 1 <br /> ❑SPECIAL OTHER <br /> 1 <br /> )ULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> IFUSAL UPON ARRIVAL. ONGOING.DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR.COPY,. MANIFEST# 342004 <br />