Laserfiche WebLink
El Keller Cpnyors,t ❑Coffin Butte ❑Ox Mountain ❑Newby Island Lel Forward <br /> Sanitary Landfill Landfill Sanitary, Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 289%72 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 8999 S.Austin.Road <br /> a 'Pittsburg,CA 94565 Cordallis, OR 97330 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> i Phone(925)458-9800 Phon�(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)72679183 Fax,(408),262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hmdwdr Rcwc+I:mrall <br /> MAILING ADDRESS <br /> Ctrs ve 6939— <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE.EQUIPMENT <br /> ca1,l A 9.5203 PHONE .GLOVES ❑GOGGLES ❑RESPIRATOR HARD HAT <br /> - <br /> 2 4469 06'25 ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> E�t.Ccolem SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE. <br /> GENERATOR'S CERTIFICATION:I hereby certify that the abode named material is not a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 ol.the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper cond€lion for transportation a carding to applicable <br /> AND,If the waste is a treatment realdue 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 requ€remenis of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W.H Itaa Ave S'I"OCKTON <br /> TRANSPORTERTru NOTES: VEHICLE LICENSE NUMBER I <br /> i TRUCK NUMBER <br /> ADDRESS:-.. <br /> x'170 T,a`tiT�vi�lta:u:l • " <br /> CITY,STATE,ZIP .. <br /> PHONE END.DUMP BOTTOM DUMP TRANS ER <br /> T2'—M 45C.I 145 i' �!.- 's ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER 4 'DA � ROLL-OFF(S) FLAT-BED VAN -DRUMS <br /> 21 <br /> ! CUBIC YARDS <br /> 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. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DI OSE OTHER <br /> 14 <br /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AVTHORIZEDAGENT DATE <br /> Q WOOD <br /> mvq� O ASH0 <br /> Q SPECIAL OTHER <br /> CHEDULING MUST BE MADE PRIORTO 3:00 RM.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-4 `5 4�° 9 09 <br /> .. V <br />