Laserfiche WebLink
❑ Keller Canyoni.J n ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanjuit Andfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Maeo 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) 458-9800 Phone (650)726-1819 Pnone (408)945-2800 Phone(209)182- <br /> Fax (925)458-9891 Fax(650)726-9183 Fax (408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> +'°� wi � )� ra� t✓.r� ��rte` <br /> MAILING ADDRESS _ <br /> r i; F/ � <br /> CITY, STATE, ZIP <br /> `" tri T JAI CT7 T <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES ❑GOGGLES Q RESPIRATOR F HARD HAT <br /> Q TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Ef SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> i A}/if�ryr r"� � 1 L iL fes } r��l is� 1T{2L E <br /> GENERATOR S CERTIFICATIONI hereby r e that the above named material is not a hazardous <br /> waste as defined by 413 CFR Part 261 or title 22toF the Cadfornia code of regulations has been property <br /> described classified and packaged and is In proper condition for transpoAation a cording 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 certdy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements.of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE `� ~f I t a <br /> .,E55 .r F e _1 L.x�S L- n sin <br /> ❑DISPOSAL Cl SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> Q DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> a -t- t <br /> ADDRESS <br /> C •ATE, P - <br /> PHO END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTIIORIZI=D AGENT OR DRIVER DATE ❑ <br /> ROLL-OFFS FLAT BED VAN DRUMS—1 <br /> U L1 <br /> sr <br /> t <br /> CUBIC YARD$ <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD <br /> Is true and accurate (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> f � <br /> ❑SPECIAL OTHER <br /> SCHEDULIN MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE SUBJECT <br /> TRANSPORTER COPY MANIFEST# 280901 <br />