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Keller Canyon ❑ Ox Mountain ❑ Newby Island ,Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill I . :> <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road AOt <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 /> :NERATOR WASTE ACCEPTANCE NO. <br /> Pac:�� �,i� � WASTE <br /> 11LING ADDRESS <br /> A"ACI— <br /> 77 Beale Street, Mail Code, B24A t>V 7 <br /> rY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fr i. C,% C.A 94 170 ❑GLOVES ❑GOGGLES ❑RESPIRATOR D HARD HAT <br /> IONE 11 <br /> ❑TY-VEK U OTHER I � <br /> )NT O <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Authorized Agent for <br /> ti <br /> Pacific Gas&Electric ................. <br /> rr Zs_ 1 <br /> i�tTuiliv <br /> JJERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> este as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <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 <br /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR Part 261. <br /> I <br /> 1 TE TYPE: <br /> ISPOSAL O SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> Ajwrntun i�eityciraiur I"ttcnrtxicm <br /> AN. . JRTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> D"Beste"brans rtation M <br /> DRESS <br /> VO Tin_Baste t <br /> rY,STATE,ZIP <br /> CA 95492 <br /> ONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> iNA9'l7R A RIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I h reby certify that the above named material has been <br /> lccepted 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 /> i Ir�:tks <br /> ❑SOIL <br /> MARKS <br /> ❑ CONSTRUCTION <br /> 1ILITY TICKET NUMBER DEBRIS j <br /> ❑ NON-FRIABLE I <br /> ASBESTOS <br /> WATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> ❑ASH i <br /> l <br /> O SPECIAL OTHER <br /> IULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> FUSAL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. j i <br /> GENERATOR,COPY MANIFEST 341925 <br />