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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 /> r' <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 /> Paoifio Gas& h1cctrk <br /> MAILING ADDRESS t <br /> 77 Bea1�Street Mail Code B24A '_J.I-t <br /> CITY,STATE;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ss�Frav�r_.iqr_.ip, CA 94105 0 GLOVES ❑GOGGLES O RESPIRATOR 0 HARD HAT <br /> PHONE <br /> D TY-VEK O OTHER <br /> CONTACT PERSON. SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE NO <br /> t .�-�IVT I <br /> et T" 11/004 <br /> Sly GENERATOR'S CERTIFICATION:f#ier - that the above named material is not a hazardous - <br /> 'waste w;defr*d by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> art:. descxitied,classified and.packaged,and is in proper condition for transportation a-:cording to applicable - <br /> ,L.9ations:AND,if the waste is,a treatment residue of a previously restricted hazardous waste <br /> subject to"Land Disposal Restrictions,t certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> i accordance with the ents of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ` 1 DISPOSAL 0 SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> D_DEBPIS, O OTHER <br /> OsSPECIAL WASTE <br /> GENERATING FACILITY <br /> t,athroQ�eFiydrat Sutton Lathrop <br /> ... �a.A.- �IhXC�"-+-'_Z�.'� sst'�',F <br /> �tNSPORT,w = f - NOTES..- VEHICLE LICENSE NUMBER TRUW`M-' MBER' <br /> �. es_ fans on <br /> ' DDRESS—— <br /> TY;STATE,ZIP )G" 13 <br /> Windsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 4 ,7n7NgAQJA 7 Ll ❑ <br /> 7 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE J ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> d / ❑ ❑ ❑ ❑ <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 /> ❑SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> ❑ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a 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 MANIFESST# / q 1 x+, <br />