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] Keller Canyon ❑ Ox Mountain ❑ Newby Island ] Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill lot <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 j <br /> F- (925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> _ I <br /> NERATOR <br /> Gas , WASTE ACCEPTANCE NO. <br /> PacificMLING ADDRESS I <br /> 77 Reale Street It 7Oil <br /> TY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Son Francigm, CSA 94170 ❑GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> TONE ' <br /> ❑TY-VEK ❑OTHER <br /> )N1'4�014173 <br /> Robert Grav 1 <br /> SPECIAL HANDLING PROCEDURES: l <br /> GNATURE OF AUTHORIZED AGENT/TITLE DATE j <br /> Adhorized Agcnt for j <br /> Pacific citta Ac E]ttric .............. i <br /> WT_ iI <br /> iENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous t <br /> aste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly t <br /> $scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable — <br /> tgWations;AND,H the waste is a treatment residue of a previously restricted hazardous waste <br /> object to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ocordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> D CFR Part 261. I! <br /> ASTE TYPE: too. <br /> 17 DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION O WOOD i <br /> ❑DEBRIS O OTHER <br /> O SPECIAL WASTE i <br /> NERATING FACILITY <br /> I4 <br /> urnton EliCnydratur a aumiun <br /> i <br /> R ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> jimBeste Transportation � <br /> )DRESS <br /> _ _ Petg .t <br /> TY,STATE,ZIP ! } <br /> Windl4cm, CA 95492 <br /> li#E <br /> LONE END DUPP BOTTOM DUMP TRA ER(7Q7)8381 - ' <br /> 3N U F_ IZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> i <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. f <br /> DISPOSE OTHER a <br /> INC <br /> :MARKS a SOIL <br /> O CONSTRUCTION i <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> NATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> O ASH J <br /> O SPECIAL OTHER <br /> i <br /> DUUNG MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT tool <br /> :.FU.SAL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. t�dlldt <br /> GENERATOR COPY MANIFEST# 341911 f <br />