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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island I 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)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR }}..... WASTE ACCEPTANCE NO. <br /> 1 azffic Gas� El1VULLlV <br /> MAILING ADDRESS AOnn- <br /> 77 Sb=A �7v.� <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco. CA 94 2'R Q GLOVES Q GOGGLES Q RESPIRATOR U HARD HAT <br /> PHONE <br /> Q TY VEK ❑OTHER <br /> CONT R O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHO IZED AGENT/TITLE DATE <br /> Audtorized Agent few <br /> Pacific Cres&Electric <br /> t o Z S_Ort ...�T... <br /> GENERATO 'S CERTIFICATION:I hereby certify that the above named material is not a hazardous Lr UiilG <br /> waste as defined by 40 CFR Part 261 or title 22 of the Califomia 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,H 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 266 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261. <br /> WASTE TYPE: <br /> ADDISPOSAL Q SLUDGE <br /> O CONSTRUCTION U WOOD <br /> UDEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> Thurnion Dchydraiur T nurniun <br /> ORTER NOTES`. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> este ra>us iUtion a /� Q <br /> S J© ! CJ D <br /> cgt� ( .t'_ <br /> TE,ZIP <br /> Windsor, C`A 95492 <br /> IPH04NE END DUMP BOTTOM DUMP TRANSFER <br /> _1 ❑ ❑ <br /> R OF HO E T OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑Gf -Z 9-vN <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 /> EMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER oEeRls <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THEDAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL..ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 341930 <br />