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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 <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Pa c.Gas&Elcctric <br /> y MAILING ADDRESS <br /> All l A- <br /> 77 Beale Street Mail Code B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San _A 94 1 A's <br /> ,f <br /> Q GLOVES Q GOGGLES U RESPIRATOR Q HARD HAT <br /> PHONE <br /> i, <br /> U TY-VEK U OTHER <br /> CONTACT PYRSN r SPECIAL HANDLING PROCEDURES: <br /> R be <br /> SIGNATURE OF AUTHORIZED/AGENT/TITLE JDATE <br /> + <br /> GENERATOR'S CERTIFICATION-,I hereby 1 the above named material is not a hazardous - <br /> .waste as defined by 40 CFR Part 261 or title 22 o the California code of regulations,has been property <br /> -described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> II regulations;AND,If"waste Is a treatment residue of a previously restricted hazardous waste <br /> ry subject b theiand Disposal i�sirlCfwns,l cedify and Warrant that the waste has been treated in RECEIVING FACILITY <br /> y. accordance with the regtarerle[tt�of'40 CM Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261_ <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> U CONSTRUCTION' U WOOD <br /> LJ DEBRIS U OTHER <br /> R; <br /> (]`SPECIAL WASTE <br /> GENERATING FACILITY <br /> Lathrop <br /> wK <br /> ORT z ' MTES VEHICLE LICENSE NUMBER 'NUMBER <br /> DDRESS <br /> - V 4VLrV.i[�J VU4V_.VM <br /> t <br /> CITY STATE,ZIP <br /> Wm4sor. CA 95492 <br /> PHONE END DUMP BOTTOM DUMP ' TRANSFER <br /> ' <br /> (707)'68-1467 ❑. ❑ <br /> SIGNATURE-0F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> c ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 1 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 /> Q SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> O ASH <br /> U 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# / q 1 R q <br />