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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island V1 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 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)45-9800 Phone(650)72671819 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 /> pacific Gas&Fh,ctn <br /> MAILING ADDRESS <br /> 77 Beek � 4. &4,p E24 1 <br /> 4A <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sao Fi E%C!A'94120 U GLOVES Q GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE- <br /> 3J. ' U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Rvh_k#CaY SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE ,7j�,( <br /> Irl lV a P- �;+�.i I <br /> 71 q i� t: 5.4 <br /> GENERATOR'S CERTIFICATION:I h y ce*that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California Code of regulations,has been properly <br /> described,classified and packaged,and is in propeCcondA an for transportation a cording to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted haiardoui waste <br /> subject to the Land Disposal RostrictKms,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 /> ?!fflISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> t <br /> t <br /> NOTES: VEHICLE P N' <br /> <br /> NUMBER " <br /> Tete=' : : <br /> ADDRESS <br /> 320 B't';rPBCSW C:M1, <br /> CITY, STATE,ZIP ,.' t,y. <br /> WftA",CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> '707 839-1407 ❑ I I ❑ ❑ <br /> SIGNATURE OF AUTHORIZfiP AGENT OR D ER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been • <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER •� <br /> EMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> i U WOOD <br /> U ASH <br /> * U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ::TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST N n r%n r-^n 4 <br />