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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 /> ail <br /> /F-NERAT0RWASTE ACCEPTANCE NO. <br /> GADDRESS4r7v.7TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Can Fr nc:ifsc C.A 9417() O GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 46 ❑TY-VEK O OTHER <br /> CON O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGN THO ED AGENT/TITLE GATE <br /> Audwriind AgeuC for <br /> Pacific Gall&Electric �� ................. <br /> GENERATOR's CERT( ICATION:I hereby certify that the above named material is not a hazardous 1�IrV�1t3 <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described, <br /> of <br /> and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,it 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 /> WA TE TYPE: <br /> ;5-DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> T�IiU>Gnivin_Uchydraior Thtarnicrn <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS' ' Transportation �- <br /> ttC .f_ <br /> CITY,STATE,ZIP <br /> 'WindsM CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGN AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> o WOOD <br /> O ASH <br /> l.* <br /> O SPECIAL OTHER <br /> SCHEDUUNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFU.SALUP.ON ARAM. ONGOING DAILY (DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> .GENERATOR DOPY <br /> MANIFEST# 341941 <br />