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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 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 /> LNATOR NON-HAZARDOUS WASTE MANIFEST <br /> ' Pacific <br /> Pacific Gas & glcctric WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> A nrbn- <br /> 77 Beale Street Mail Code B24A 't7V7 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fromk-otsu_-�oCA 9412.0 U GLOVES U GOGGLES L]RESPIRATOR LI HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTH IZED AGENT/TITLE DATE <br /> - Authonzed Agent fiw <br /> Pack Lias&Aeolic `/� � ......,..,.. <br /> ,1"4KII <br /> r c/ <br /> iruue <br /> GENERATOR' 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 tftc 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 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> 4:bISPOSAL O SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> rnornion 13chydi-aior !nvrnion <br /> a ANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> esti Yrattspgrtation lJ/ 6 <br /> ADDRESS / <br /> _ cert, r ncte: t , <br /> CITY, STATE,ZIP <br /> Windsor, 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 7(l IR _1 ! ❑ ❑ <br /> SIGNATURE OF AU tdORt?�ED 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 /> EMARKS 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 /> 4 <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUS <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY V' <br /> GENERATOR COPY MANIFEST# 341" <br />