ARCHIVED REPORTS XR0009874 - Laserfiche WebLink

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-r ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward ' Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road Ptttsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 ' Phone(925)458-9800 Phone(650) 726-1819 Phone(408) 945-2800 Phone (209) 982-4298 Fax (925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 • NON-HAZARDOUS WASTE MANIFEST ' GENERATOR WASTE ACCEPTANCE NO. MAILING ADDRESS CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT PHONE tI GLOVES 0 GOGGLES ❑RESPIRATOR O HARD HAT ' F ❑TY VEK ❑OTHER CONTACT PERSON SPECIAL HANDLING PROCEDURES SIGNATURE OF AUTHORIZED AGENT/TITLE DATE S Y C£ Y ' GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or tide 22 of the Calilornia code of regulations has been property described classified and packaged and is in proper condilion for transportation a-carding to applicable regulations AND,it the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by ' 40 CFR Pan 261 WASTE TYPE •DISPOSAL a SLUDGE a CONSTRUCTION O WOOD ❑DEBRIS ❑OTHER ❑SPECIAL WASTE GENERATING FACILITY TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER ADDRESS CITY, STATE,ZIP ' PHONE END DUMP BOTTOM DUMP TRANSFER SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS � r^ ' CUBIC YARDS hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing' Is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) DISPOSE OTHER ' REMARKS D 50tL ❑CONSTRUCTION FACILITY TICKET NUMBER DEBRIS ❑ NON-FRIABLE ' ASBESTOS SIGNATURE OF AUTHORIZED AGENT DATE ❑WOOD ❑ASH - ❑SPECIAL OTHER SCHEDULING MUST BE MADE PRIORTO 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT ' TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE MANIFEST it ';r SALES COPY {'.