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l Keller;Canyon ❑ Ox Mountain ❑ Newby Island [% Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill tt u <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road4lttt <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 /> F--"1925)458-9891 Fax(650)726-9183 Fax(408) 262-2871 Fax(209)982-1009 I�I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> t <br /> :NERATOR WASTE ACCEPTANCE NO. <br /> paci 7c vies",iiccii>,e:. I <br /> tILING ADDRESS <br /> A nnQ— <br /> 77 Beale Street 1VW1 Code B24A `*'v 7 <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fr-lnc:zsc,_� CA 94120 0 GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ZONE <br /> ❑TY-VEK ❑OTHER on <br /> )NT CT� ER O-�� <br /> SPECIAL HANDLING PROCEDURES: <br /> aNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> n Autdorizai Agent for/ <br /> &c ...............Pac"8c Ges Electric <br /> None <br /> :NERATOR'S CERTIFICATION:I hereby certify that the above named mater al is not a hazardous <br /> tste as defined by 40 CFR Part 261 or fitle 22 of the California code of regulations,has been property <br /> scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by _ <br /> CFR Part 261. <br /> 1 <br /> \ TYPE: <br /> ISPOSAL ❑SLUDGE {p� <br /> ❑OONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> i <br /> :NERATING FACILITY <br /> 111ti 3chydmiar 'A hutuion I <br /> t <br /> Mo.-ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> LVtWesteart I <br /> (DRESS — I <br /> rY,STATE,ZIP <br /> �q� x,, <br /> W mdwr CA 5492 r W I}I <br /> ZONE END DUMP BOTTOM DUMP -IRAN F R 601110 <br /> [707193R-1407 ❑ ❑ <br /> 3NA UR OFA HORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN IDFkJMS { <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS �II <br /> f <br /> I hereby certify that the above named material has been i <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 1911 a i <br /> ❑SOIL <br /> MARKS <br /> ❑CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE <br /> O WOOD ' <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> MUST BE MADE PRIOR TO 3:00 P.M.THEDAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT ! O H 4I tf <br /> $AL'UP.ON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. i tl p#A <br /> GENERATOR COPY MANIFEST* 3 41 q 4 9 <br />