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t <br /> ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island goorward <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 IL p ��ww.. WASTE ACCEPTANCE NO. <br /> Pacific ac�4 Gras & El.cctric <br /> MAILING ADDRESS <br /> n gAg— <br /> 77 Beale Street. Mail a)dc 1324A t v� <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sart F e. 00 CA 94121) Q GLOVES Q GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> -- U TY-VEK Q OTHER <br /> CON C ER O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIG E OF AUTHORIZED AGENT/TITLE DATE <br /> Adhoriud Aged for <br /> Pacific &mect ie <br /> 1012-1. .. <br /> "8iiir <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <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,If 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 268 aril is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> T"nomi i'n DulAY <br /> draWy i'?�urnion <br /> RANSPORTER NOTES: VEHICLE LICENSE NUMBERT TRUCK NUMBER <br /> 0en1kAc '1'ransportattan <br /> ADDRESS <br /> R20 egtP <br /> CITY,STATE,ZIP <br /> Win&qor, CIA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGN URE-OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DR MS <br /> ❑ ❑ ❑ ❑ <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 <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> kACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑wooD <br /> 01 <br /> g i7r,. U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 PEM.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUI3:P <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY Bol <br /> GENERATOR COPY MANIFEST 8 3 4 10-Y <br />