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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island OForward <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 Halt 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 /> I-Ia . (3a- o_ t';"'tC <br /> i aVt v vaa cx, uiwe,t,AiC <br /> MAILING ADDRESS _ <br /> 77 11cale, Sih=t. Mail ( ode 2 Riova <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ,SartFranciaec) C'. 9417_.0 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> (4151973-37-73 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Robert (iray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUT RIZED AGENT/TITLE DATE <br /> / Awhorized Agent for <br /> Pacific Gas&Electric ... ­1 .. <br /> 1 V UiIQ <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,if 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 CFR Part 261. <br /> WASTE TYPE: <br /> VDISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> nomwn OtAtyurator i-nornion <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ventiete l ranspartatic�n �"�" <br /> ADDRESS f, <br /> CITY, STATE,ZIP <br /> -Windsor- CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707W38-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS— <br /> L) <br /> RUMS❑ ❑ ❑ ❑ <br /> /-9- 2 5'-a <br /> CUBIC YARDS <br /> 1 freby 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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> ❑ASH <br /> *` O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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# 341932 <br />