Laserfiche WebLink
❑ Keller Canyon <br />Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458.9891 <br />[-]Coffin Bi -fie <br />Landfiil'%► <br />28972 Coffin Butte Road <br />Corvallis, OR 97330 <br />Phone (541) 745-2018 <br />Fax (541) 745-3826 <br />El Ox Mountain <br />Sanitary Landfill <br />12310 San Mateo Road <br />Half Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />❑ N—tby Island ❑�?k? arrd <br />SissAtary Landfill <br />1601 Dixon Landing Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <br />Fax 1408)262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERATOR <br />WASTE ACCEPTANCE NO, :,,r_;: <br />LLQ' <br />MAILING ADDRESS <br />_ <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />`1 I I` 7-X_ - - .T �• S <br />❑ GLOVES ❑ GOGGLES O RESPIRATOR ❑ HARD HAT <br />O TY-VEK U SAFETY VEST <br />PHONE '�- 1 41 - -?'- - - <br />CONTACT PERSON /r 7 ,- `' <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT / TITLE- <br />DATE <br />71 <br />GENERATOR'S CERTIFICATION. I hereby cenity that the above named material is not a haraoeabs <br />waste as defined by 40 GFR Part 261 or are 22 of the California code of regulations, has bean property <br />tlascdbeQclassified and packaged, and is in proper condition for Transportation a -cording to applicable <br />regulations; AND, If the waste Ie a treatment residue of a prevluusty restricted heratdous waste <br />subject to the Land Disposal Restrictions, I certify and warrant that the waste has been treated in <br />accordance with the requirements of 40 CFR Pad 266 and is no longer a hazardous waste as defined by <br />40 CFR Pad 261. <br />_ <br />RECEIVING FACILITY <br />WASTE TYPE: <br />G DISPOSAL O SLUDGE <br />OCONSTRUCTION OWOOD <br />❑ DEBRIS ''OTHER <br />❑ SPECIAL WASTE 17 <br />- <br />GENERATING FACILITY <br />TRANSPORTER _� _ 1' �' _{ <br />NOTES: VEHICLE LICENSE NUMBER .TRUCKNUMB R <br />n <br />-d <br />ADDRESS c, J <br />CITY, STATE, ZIP o c ;- ✓ G iy <br />PHONE <br />END DUMP DOTTOM DUMP TRANSFER <br />SIG E OF AUTHORIZED AGENT -OR DRIVEPf <br />JDATE <br />ROLL -OFFS) FLAT-BED VAN DRUMS <br />,y r <br />❑ ❑ ❑ <br />I hereby certify that the above named material has been <br />accepted and to the best of my knowledge the foregoing <br />Is true and accurate. <br />CUBIC YARDS <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑ SOIL <br />REMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />❑ NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT <br />DATE <br />❑ WOOD <br />I] ASH <br />❑ SPECIAL OTHER <br />SCHEDULING MURT BE MADE PRIORTO 3:00 RIM 1 HE DAY PRIORTO EXPEC`E.D ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br />TO REFUSAL UPON ARRIVAL. ONGOING DAII.'- ")E;_iVE` IES MUST BE SCHEDULED WIT. n TH= LANDFILL THE DAY BEFORE. <br />MANIFEST 0 n in, in of 1 <br />(2FNFRATOR COPY - <br />