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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)45> '9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST I <br /> :NERATORit11lt <br /> WASTE ACCEPTANCE N0. I <br /> I <br /> ULING ADDRESS anon <br /> — <br /> 77 Beale Street Mail Code B24A 1t7t.?7 <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S Franr^i <br /> cr <br /> IONE _,D C A 94170 ❑GLOVES U GOGGLES U RESPIRATOR O HARD HAT <br /> ' <br /> (4i 5�973-3773 <br /> Q TY-VEK U OTHER <br /> )NT T ER ON <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> AUdKWizcd Agcd for <br /> Pacific C3an&Electric <br /> ,.,.___ 11�Dfl'I <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1`IUtIlt' <br /> we as defined by 4o CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste j <br /> too b the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> =rdance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> I CFA Part 261. <br /> %STE TYPE: <br /> O DISPOSAL U SLUDGE <br /> •CONSTRUCTION Q WOOD <br /> O DEBRIS U OTHER <br /> •SPECIAL WASTE <br /> :NERATING FACILITY <br /> Thumikn—136hyuraiur 'I"n0YUikM <br /> .,, ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK N MBER tool <br /> sate I rans rtat ion <br /> ►4RES5 g <br /> n.tete- _t_ i <br /> rY, STATE,ZIP <br /> Windsor <br /> [ONEEND PUMP BOTTOM DUMP TRANSFER <br /> nnwl 407 ❑ ❑ I <br /> 3NA UR UT RI AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS I <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> i <br /> hereby certify that the above named material has been r <br /> accepted and to the best of my knowledge the foregoin <br /> is true and accurate. g DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) 1 <br /> DISPOSE OTHER <br /> •SOIL I k <br /> :MARKS <br /> •CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> •NON-FRIABLE <br /> aNATURE OF AUTHORIZED AGENT DATE ASBESTOS tFI <br /> •WOOD <br /> •ASH <br /> U SPECIAL OTHER <br /> DOLING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT , <br /> cFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> DAY <br /> BEFORE. <br /> GENERATOR COPY MANIFEST# 341924 ' <br />