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❑,Kellera ❑ 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 /> JNON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> I�A <br /> V�11�11riap pM�Ri'I.NVLL V <br /> MAILING ADDRESS <br /> 77 Beale Street Mail Code 2 a nnn— <br /> "r7v_7 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> L: FrBr►Oif:r_.n CA 94120U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONT CT PERSON- <br /> Robed <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Audwrized Agent for <br /> ` Pacific Ow&Electric / ... <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 /> described,Classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,N 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 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 'Thonntcm Duhydratvr Thvrnttm <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> este Trans tion jr <br /> ADDRESS 1� <br /> _ -n Ofatc. _;t. <br /> CITY,STATE,ZIP <br /> Winds= CA 9549-2 <br /> PHONE END DUMP BOTTOM DUMP '.IRAN FER <br /> (707)838-1402 ❑ " Q <br /> SIGNATURE F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN UMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> U SOIL <br /> REMARKS <br /> U 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 /> U 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* 34194 <br />