Laserfiche WebLink
El Keller Canyon ❑ Coffin But#e ❑Ox Mountain ❑ Newby Island IN Forward <br /> Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis,OR 97330 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca, CA 95336. <br /> "Phone{925}458-9800 Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)9824298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> H ager Repour ens <br /> MAILING ADDRESS _ <br /> 4M7Ave <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> UtcWcni`CA GLOVES 0 GOGGLES Q RESPIRATOR YO HARD HAT <br /> PHONE <br /> C2-0b 469-0625 0 TY-VEK 0 SAFETY VEST <br /> CONTACT PERSON <br /> BrdtCcdscn SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR'S CER11FICATION:I hereby certity,that the above named materiel Isnot a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is In proper condition for transportation a-.00rdirrg to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrent that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> X DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION Q WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2()?S W,Hlkolt Avc STt 'E:'TQN <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Mr Trtlter <br /> ADDRESS <br /> 2 47 <br /> 710 L*xnis Road f(�l �` <br /> CITY,STATE,ZIP <br /> St a.4CA 952D5 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Z 45&1145 <br /> SIGNATUFIJE OF AUTHORIZEPAGET OR DRIVER DATE. ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of Illy knowledge the foregoing DISPOSAL METHOD: (TO BE COMikETED BY,LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> EMARKS <br /> Qi CONSTRUCTION <br /> DEBFACILITY TICKET NUMBER NON- 5 <br /> O NON-FRIABLE " <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> t]ASH <br /> �1 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> fO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> OENERATOR COPY MANIFEST# 5-6 <br /> 4 7 <br />