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] Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill j Oki <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road a1 I <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 /> :N Pacific <br /> WASTE ACCEPTANCE NO. <br /> l�a;,i�e CYas � 1l;:ct,r�:, <br /> ULING ADDRESS <br /> Anon— <br /> 77 Reale Stmt `t 7 7 <br /> rY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT i <br /> San Frap-i^icc.o CA 1)417.0 i <br /> 0 <br /> TONE GLOVES 0 GOGGLES U RESPIRATOR ❑HARD HAT <br /> U TY-VEK 0 OTHER !< I <br /> )N O <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE tDATE <br /> Anari7r-d Ager t for <br /> Pacific Chm& lectric G. ................. <br /> :E <br /> None <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> asle as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> rscribed,classified and packaged,and is in proper condition for transportation a-,cording to applicable <br /> gulations;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 /> xordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 3CFR Part 261. <br /> 4STE TYPE: b <br /> ISPOSAL ❑SLUDGE . <br /> 0 CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER E <br /> O SPECIAL WASTE I <br /> NERATING FACILITY <br /> umiun Dchydratur nup-nion <br /> IAN�,rORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mmi-Heste Transportation , <br /> )DRESS <br /> R70 TlIt-nBestte(X <br /> rY,STATE,ZIP <br /> k <br /> Y it It <br /> LONE END DUMP BOTTOM DUMP TRANSFER ! tt <br /> ❑ ❑ <br /> 3NATU,W(YF_ATJ,THORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 V O'V <br /> :MARKS ❑SOIL <br /> O CONSTRUCTION <br /> ,CILITY TICKET NUMBER DEBRIS <br /> ASBESTOSLE <br /> 3NATURE OF AUTHORIZED AGENT DATE <br /> L)WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> I <br /> G MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT 14 s l <br /> AL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, iI <br /> GENERATOR COPY MANIFEST 1t 3 4 1 9 2 3 , <br />