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Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary and Sanitary Landfill Sanitary Landfill Landfill I " <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 /> :NERATOR WASTE ACCEPTANCE NO. <br /> 1(34WV Gas <br /> t71.Elfri, <br /> JLING ADDRESS <br /> 77 Reale Street MA Code 1324A 4909— <br /> STATE, <br /> 909— <br /> STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sall Frnrifi CA 941 20 <br /> ONE 0 GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> P '— O TY-VEK O OTHER <br /> INTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> 'N URE OF AUTHORIZED AGENT/TITLE DATE <br /> Att4hrxi25ei Agad for <br /> Pacific(3*8,S Electric <br /> /1 ✓ wt--- - I 0 o o t <br /> :NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1 ' <br /> ate as defined by 40 CFR Part 261 or fide 22 of the California code of regulations,has been properly - <br /> sorbed,classified and packaged,and is in proper condition for transportation a-cording toapplicable <br /> �ulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> bject to the land Disposal Restrictions,I oertity and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR Part 261. <br /> 6TE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑ ONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> I <br /> :NEflATING FACILITY <br /> "Nornion'Duhydraior 11101nion <br /> 'PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER '#` <br /> nlieste l ransportation <br /> DRESS I <br /> Den ate t_ <br /> STATE,ZIP <br /> Windsor, CA 95492 <br /> ONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ L) f <br /> 'NA R OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D UMS <br /> l asap <br /> CUBIC YARDS t <br /> there y ertify that the above named material has been <br /> lccepted nd to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> MARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> XITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE j <br /> ❑WOOD f @ <br /> (3 ASH <br /> ❑SPECIAL OTHER l <br /> )ULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a 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# 341960 <br />