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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 /> JGENERATOR'(yg �� WASTE ACCEPTANCE NO. <br /> 1 ac�ti Gag & E.1WLLt AC <br /> ILING ADDRESS <br /> 77 nA*1P Ct"....* h4o4l r.,,tA 1111A A "t7V7— <br /> ❑ 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 /> All NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 11av1uC Gas&ulticctdc <br /> MAILING ADDRESS <br /> 77 Beale Stmr4 Mail Code'A24A Y7V7 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fm__P_ _gg-p CA 9417.6 Q GLOVES U GOGGLES U RESPIRATOR Q HARD HAT <br /> PHONE <br /> Q TY-VEK U OTHER <br /> CONTACT-PER-SON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Av&onzed Age rd&x <br /> Pacific Gae&Electric .. ..........,....... <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1;UUe <br /> waste as defined by 40 CFR Part 261 or title 22 of 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 /> regulations;AND,H the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> Tbornion I�hyditaicn nvn�iun <br /> ANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> e:3te ranspotUtton <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> Mindm, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGN A FAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DF31 IMS <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 /> U 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 /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P M.THE DAY PRIQRTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES IEOM DSTMANIF <br /> UST BE SCHEDULED WITH THE LANDFILL <br /> L THE <br /> 419 BEFORE. <br />