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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Pdi 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 PhonO(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(�09)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST - - <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> L�1 + 1.� Vat!kv,11 <br /> MAILING <br /> MAILING ADDRESS <br /> 77 Beale Sh-ea Mail Code.B24 A n Tenn— <br /> Irav;? <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco CA 941.20 U GLOVES Q GOGGLES LI RESPIRATOR Q HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert C-iray <br /> SIGNATURE OF AU`THORIZ AGENT/TITLE DATE <br /> Authorized A,geut for <br /> Pacific Cies&Electric ( d L ................. <br /> lvuu� <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 property <br /> describe=daasiried 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,1 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 Par 261. <br /> WASTE TYPE: <br /> ❑dMISPOSAL U SLUDGE <br /> CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> i wmicnb irchyc rain i harnron 1 <br /> Y <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> etWeste 'ransportabon f' _ <br /> ADDRESS` Cie <br /> 92-0 €Ste CL <br /> CITY,STATE,ZIP <br /> Win(NoL CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)939-1407 ❑ ❑ <br /> SIGNATURE OFA THORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN UMS <br /> ❑ ❑ ❑ ❑ <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 /> O <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE.PRIORTO 3:00 P..M.THE DAY PRIOR TO EXPECTED'ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> J IF UPON ARRIVAL.-ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE.LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 341938 <br />