Laserfiche WebLink
u Mprov+ vcattlyvtt LJ VA IVIUuntaln LJ Newoy Islana iI fOrwarCJ <br /> Sanitary Landfill Sr-,tary Landfill Sanitary Lam- dfill Landfill <br /> 901 Bailey Road 121tSan Mateo Road 1601 Dixon La, -.-Ig Road 9999 S.Austin Road <br /> 95 i <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 035 Manteca,CA 95336 1 <br /> Phone(925) 458-9800 Phone (650) 726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982409 } <br /> y <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. i <br /> MAILING ADDRESS' <br /> CITY. STATE,—ZIP ' ' -� r ------ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CA <br /> ❑GLOVES ❑GOGGLES 0 RESPIRATOR O HARD HAT <br /> f 0 TY-VEK 0 OTHER �� <br /> CONTACT-PEFtS09 <br /> J-7SPECIAL HANDLING PROCEDURES: <br /> .. <br /> SIGNATURE OF AUTHORIZED AiaIENT T-h `E-' DATEAw <br /> I <br /> h <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-carding 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 warrant that the waste has been treated in REC€IVING.FACILITY <br /> accordanda with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part'261.` — <br /> WASTE TYPE; tom, <br /> O DISPOSAL U SLUDGET` ! <br /> ❑CONSTRUCTION U WOUD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE - r <br /> GENERATING FACILITY , r <br /> TRANSPORTER- t " ti f� NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADORE S' gle-3S_ 40, <br /> .. I <br /> s; <br /> CITY STATE,ZIP" 17 <br /> RHONE - -- - _ - - _ _END ,UMP - BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S)' FLAT-BED VAN DRUMS <br /> r <br /> ❑ ❑ ❑ ❑ <br /> CUBIC:YARDS <br /> —.Therebycettify that the`abave named material has b"eeri� <br />` accepted and to the best of my knowledge the foregoing. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> i is true and accurate. <br /> i . <br /> ' DISPOSE T OTHER <br /> " 0 SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑ NON-FRIABLE <br /> i i r ASBESTOS <br /> SIGNATURE OFAUTHQRIZEDAG1ENT DATE I. <br /> uSASH <br /> i <br /> � Q SPECIAL'OTHER3" <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED.ARRIVAL-ANY UNSCHIwDLILED.LOADS ARE SUBJECT' <br /> TO REFUSAL UPON ARRIVAL. bNGOING DAILY DELIVERIES MUST BE'.` '4 ULE­6A <br /> ifF _aTHE LATIDFILL THE DAY BEFORE. <br /> GENERATOR COPY < < ! - M EST# 444625 r, <br /> q <br />