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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 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 /> NON-HAZARDOUS WASTE MANIFEST a' <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Pam O&-&Electric <br /> MAILING ADDRESS <br /> 77,-8 Sit,It'Irai! H24A <br /> .CITY,STATE,ZIP : REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S BA941?0 O GLOVES 0 GOGGLES 0 RESPIRATOR D HARD HAT <br /> PHONE <br /> (415'9 r3�3'773 • 0 TY-VEK O OTHER <br /> CONTACT:PERSON, <br /> Rcpt GraySPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE IST 6 jA1'j5' <br /> GENERATOR's CERTIFICATION:I hereb' ity that the above named material is not a hazardous ^. <br /> r :-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 /> tegulaPwns;AND,If the waste Is a treatment residue of's previously restricted hazardous.waste <br /> 9ubect to the;Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY ' <br /> pCxo(dance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> gt40 CFR Part 261. <br /> STETYPE: <br /> DISPOSAL U SLUDGE <br /> �}CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> t DehyclCcau)r st:-»i�',.a LAT11.sROP <br /> ORTER NOTES- VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDEI S + <br /> CITY,STATE ZIP ', <br /> "`}Vindsor.CA 9549, <br /> PHONE END D MP BOTTOM DUMP TRANSFER <br /> (707')338-140 ❑ ❑ <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ a <br /> r 45 <br /> /64- <br /> CUBIC YARDS <br /> 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 /> O SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> GENERATOR COPY MANIFEST# 2 8 '7�q <br />