Laserfiche WebLink
'� ir 's2a" a ane,"r ran '9m st c c �,8^*v <br /> nnftary Landfill �r t� mita y Laid l l s' = x,San I y,� '� , _ Landfill y <br /> ,E n zs�r �, ��= k r I,nTsr��Y <br /> LOS <br /> ley Roc r 4,; 1231 Sar of kateo ioa� i 1601,DIxoNLa irng Road 9999S Austrn Road <br /> Pittstirg;GA 94565` Halt Moon Bay,C�4',94Q19 Mrlpltasx CA 9Sp35" � Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 o Fax(650)726-9183 Fax(408)262--2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST = <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> �I <br /> MAILING ADDRESS L�/ lo <br /> CITY,STATE, ZIP -2- REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 0 GLOVES 0 GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> U TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURE <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR S CERTIFICATION thereby certsy that the above named material:s 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 to proper condition for transportation a-votdnng to applicable <br /> regulatwns AND,11 the west*is a tirsaWwnt residue of a previously matrieted hazardous waste <br /> subject to the land Disposal Restrwtloris I certity and warrant that the waste has been treated in RECEIVING FACILITY <br /> awvrdance with the requirements of 40 CFR Part 266 and is no kmger a hazardous waste as defined by <br /> 40 CFR Part 269 <br /> WASTE TYPE <br /> 0 DISPOSAL II SLUDGE <br /> Q CONSTAUCT10N 0 WOO <br /> C]DEBRIS HER if{ <br /> 0 SPECIAL WASTE <br /> GENERATINq FACILITY M <br /> TRANSPORTER„ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER ; <br /> r <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> t ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> fr <br /> CUBIC YARDS <br /> 1 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 COMPLE=TED BY LANDFILL) <br /> Is true and accurate -f <br /> DISPOSE OTHER <br /> Q SOIL <br /> REMARKS 1 ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZ D 4GENT DATE <br /> 0 WOOD <br /> A <br /> 1 7k ECIAL OTHER , <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONPOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> w MANIFEST `/^1�_ ■//�'■//()�/?�]� <br /> i' ' 4 tcross srr,wrrtd rlV .GENERATOR!C.OPY rk Yj�(w'aro+:.ga< .*.-nY4r i•^ x�`t�;f � c c� S' <br />