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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)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 /> Pacific ~ &Ekadc <br /> MAILING ADDRESS <br /> 77 Re-aln Stred— Mail Code T04 A <br /> n n r►n— <br /> �t�v� <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sm Franc.iqno, C'A 94 170 O GLOVES Q GOGGLES Q RESPIRATOR O HARD HAT <br /> PHONE <br /> Q TY VEK Q OTHER <br /> CONTA <br /> SPECIAL HANDLING PROCEDURES: <br /> Robed f—w, <br /> SIGNATOPS OFAUTH0,RIZED AGENT/TITLE DATE <br /> Auliharizcd Agett for <br /> Pacific lies&Electric <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous "One <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;ANR if the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the lard Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> 1 FVISPOSAL Q SLUDGE <br /> Q CONSTRUCT14J Q WOOD <br /> Q DEBRIS Q OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> Thornton E!unydraWr. Thorniun <br /> RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> D7enffleste Transpoftation <br /> ADDRESS <br /> 820 Dipp-B -ste.(_'.t_ <br /> CITY,STATE,ZIP <br /> Win&qarCA <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (:Z0712-12-11 AA7 ❑ ❑ <br /> SIGN IZED AGE OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN ZDRUMS <br /> T ❑ ❑ ❑ ❑ <br /> 7k 4 -o y <br /> AF <br /> CUBIC YARDS <br /> I 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 /> Q <br /> REMARKS SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Q ASH <br /> O SPECIAL OTHER <br /> "'SCHEDULING MUST BE.MADE PRIORTO 3:00 P.M.THE DAY:PRIORTO EXPECTED ARRIVAL*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# 341931 <br />