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D 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 /> GENERATOR ��vv �+ WASTE ACCEPTANCE NO. <br /> AllG14fV Gas &El.cc4u tin <br /> MAILING ADDRESS A[1f1f1- <br /> 77 Beale Street Mail Colk B24A 1r7v> <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San FmnOiarO CA 941 2.0 0 GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE <br /> O TY-VEK O OTHER <br /> CONT CT ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert GM <br /> SIGNAT E OF AUTHORIZED AGENT/TITLE DATE <br /> AWhori.ed Aged for <br /> .'Pacific(IM&Electric . ......I....... <br /> 1YU69fr <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 rifle 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,l oertlfy 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 PaR 261. <br /> WAST TYPE: <br /> QA�ISPOSAL U SLUDGE <br /> /U]CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> ihviriign"Ung raiur i►urtiivn <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> cste"1 ransportattoxt <br /> ADDRESS CJ <br /> -- t'.n_efg c, - r <br /> CITY,STATE,ZIP <br /> Of <br /> Wifndsox CA 95491 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 7 _ d ❑ ❑ <br /> SIGN URF OF AUTHO IZE AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> I X_001 <br /> CUBIC YARDS <br /> I h by 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 /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> WE U WOOD <br /> U ASH <br /> 0 SPECIAL OTHER <br /> tHEDUL:ING'MU57 BE MADE PRIGA TO QD P'M THE ii4 � hiI jJ TO EXPECTED ARRIVAL•ANY UN$CHEDULED LOADS ARE SUBJECT <br /> TO.REFtJSAt URON ARRIVAL. ONGo N.0 DA1L,Y ff L1y1E=RIES MUST BE SCHEDULED WITH THE LANDFLI L T#11� DAY BEFORE. <br /> f FmF—RAToR copy MANIFEST N q�j <br />