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Keller.Canyom ❑ Ox Mountain ❑ Newby Island 'Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 904 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 /> , trl;l�c <br /> :NERATOR WASTE ACCEPTANCE NO. Reif <br /> Pacific r a .11 <br /> AILING ADDRESS <br /> 77 Reale: Street Mail Code R24A 4909 <br /> FY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Frandsca (A 9412..0 � <br /> ZONE atLOVES O'GOGGLES O RESPIRATOR a1li RD HAT <br /> "' 973-3773 U TY-VEK U OTHER I <br /> )NT CT PERSON i <br /> Rfibegl C SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 1 Authorized AgcrA£or <br /> ^ .. Paific Gas&FJectric <br /> E:NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> isle as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property I <br /> recribed,Classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gufatiorls;AND,if the waste Is a treatment realdue of a previously restricted hazardous waste <br /> biw i <br /> to the Land Disposal RestrictionsI certify Part <br /> and warrant that the waste has been treated in RECEIVING FACILITY <br /> >cordance with the requirements o140 CFR PPart 268 and is no longer a hazardous waste as defined by i <br /> I CFR Part 261_ I '`^.1 <br /> \STE TYPE: f' <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> - T"•c��-a►ic�n i�cnyciraic�r `invmion � o_ .l <br /> PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER `f <br /> DenF3eae Trans rtatiorz c}G <br /> DRESS <br /> 820.31nn eegte C'.t. <br /> rY,STATE,ZIP <br /> Windsrw CA <br /> ONE END DUMP BOTTOM DUMP TRANSFER } <br /> D 1RA -1 df17 ❑ ❑ ` <br /> 'NA7URE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS 1 0t <br /> I hereby certify that the above named material has been <br /> iccepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> MARKS U SOIL {I <br /> U CONSTRUCTION <br /> ILITY TICKET NUMBER <br /> DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> iNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> O SPECIAL OTHER j <br /> )ULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*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# 342010 <br />