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E lellek .i Y[] Ox Mountain Newby Island ' <br /> Forward <br /> Sanitary 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> I aeffic Gas &Elicet is <br /> MAILING ADDRESS <br /> A!loll— <br /> 77 Beale. Sftet Mail Code.B24 A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Franciwo CA 941.20 <br /> PHONE U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNA E OF AUTHORIZED AGENT/TITLE DATE <br /> 1Attilulrized Agent for <br /> /Pacific am&h1e-ctric J� / ............. <br /> GENERATOR'S CERTIFICATION:thereby certify that the above named material is not h ardour quilt <br /> waste as defined by 40 CFR Part 261 or dile 22 of the Calffomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;ANR I(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 /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> i Thmnicm 1'jufiydraim itrtir>tirnt <br /> 'RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> nrieste fransporUtion /r ) <br /> ADDRESS.82.0 <br /> _e-i e-s -- <br /> CITY,STATE,ZIP <br /> WindsK CA 95492 <br /> PHONE END DUMP 92TTOM DUIwIP: °'-TRANSFER <br /> IGNATUREDFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT6BE6' ' -VAN D.UMS <br /> CUBIC YARDS <br /> 1 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 /> REMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITYTICKET NUMBER . DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDUU14G MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO`, XPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING'DAILY DELIVERIES MOST BE SCHEDULED WITH THE LANDFILL THE DAY BEF�RE. <br /> GENERATOR COPY MANIFEST# 3 4 1 9 5 <br />