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Kellerk .9y"Q . ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary anciifitl 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 j <br /> : a000 <br /> 4iNERATOR WASTE ACCEPTANCE NO. <br /> I a1..wh Vas � L1W lA V <br /> AILING ADDRESS <br /> n nnn— j <br /> 77 Beale Street ail Crxic R24 A <br /> TY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisoo CA 94120 ❑GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> IONS i <br /> Q TY-VEK ❑OTHER <br /> )NT CT- ERSON <br /> Riiberf C113214 SPECIAL HANDLING PROCEDURES: I� <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE 1 <br /> l <br /> Audwr t;md tgad for <br /> ific Gas&FJectiric <br /> l It�tr l <br /> iTour flI <br /> ENERA7OR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous I <br /> tste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property + <br /> racrbed,classified and packaged,and is in proper condition for transportation a-,Cording to applicable II <br /> pulations:AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> b, Disposal to the land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY I <br /> cordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> I CPR Part 261. <br /> kSTE TYPE: <br /> ISPOSAL Q SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> Q DEBRIS Q OTHER <br /> O SPECIAL WASTE I <br /> :NERATING FACILITY <br /> ihurnicin Dcfiyciraivr 4 itvrnicm <br /> W � + <br /> Ah,. JRTER NOTES: IVEHICLE LICENSE NUMBER I TRUCK NUMBER l A` <br /> MnHeste t ransportabon <br /> DRESS ^� i <br /> _ Pn egt� ( .t. <br /> Y,STATE,ZIP <br /> Windm CA 95492 <br /> ONE END DUMP BOTTOM DUMP TRANSF R <br /> (707)RIR-1407 ❑ <br /> INANURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 'DRUMS I ` <br /> ❑ ❑ ❑ [] <br /> CUBIC YARDS lF> Q <br /> hereby certify that the above named material has been <br /> Iccepted,and to the best of my knowledge the foregoin <br /> is true and accurate. g DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) I <br /> DISPOSE OTHER <br /> 1AARKS Q SOIL <br /> Q CONSTRUCTION <br /> ;ILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> NATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> II F <br /> Q ASH <br /> I <br /> Q SPECIAL OTHER <br /> 1ULING M OT BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL ANY UNSCHEDULED LOADS ARE SUBJECT <br /> FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 341958 <br />