Laserfiche WebLink
L Keller Canyon LI Coffin'"Butte " , Ox Mountain El _Newby Island Forward M <br /> Sanitary Landfill Landfill� Sani#aryLandfill `tory Landfill Landfill <br /> 901 Bailey Road" 28922 Cof#InTutte Fuad -_ ..: .12310.San_Matea Road 1 Djxon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 'Manteca, CA X336-t <br /> Phone(925)458-9800 Phone (541) 745-2018 Phone(650)"726-1819 Phone (<408) 945-2800 Phone (20".982-4,29,Q <br /> Fax (925) 458-9891 Fax (541)'7-5-3826 _ Fax (650) 726-9183 Fax(408)262-2871 Fax(209 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. # <br /> MAILING ADDRESS <br /> 205C*SOU&IHoUy leve " <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ,CA953414 CXGF_OVES ❑ GOGGLES ❑ RESPIRATOR M HARD HAT <br /> PHONE r" <br /> (204 B-34,7070' ❑TY-VEK XSAFETY VEST <br /> CONTACT PERSON " <br /> e Oym <br /> . SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE i <br /> GENE6A70R'S CERTIFICATION:I hereby certify that the above named mate"a1 is not a hazardous <br /> waste as defined by 40 CFR"Part 281 or title 22 of the California code of regulations,has been properly <br /> .described,classified and packaged,and is in proper condition for transportation accord'[ng to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste - <br /> subject <br /> totheLand DisposalRestrictions,Icertify,andwarrant that the waste.hasbeen treatedin . RECEIVING FACILITY <br /> _accordance with.the_requirements of,40.CF.R Part 268.and.is no.fonga a hazardous waste as definetl by,. : . ' <br /> 40 CFR Part261. _ <br /> -: WASTE TYPE:- — <br /> SI <br /> C F rg 1d�fa� ► <br /> ❑CONSTRUCTION Q WOOD <br /> .❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2050 RO€Y Dvive. TRACY <br /> TRANSPORTERNOTES: VEHICLE.LICENSE NUMBER 'TRUCK NUMBER <br /> ADDRESS <br /> Pod offide "R4'7 <br /> CITY, STATE, ZIP <br /> IBCA 9541€ z: <br /> PHONE_-rmm. r_ w _r , — 'END_DUMP_—.—_-_ BO_T_T_OM_DUMP- ".TRANSFER <br /> ® D C] <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE R L FF S FLAT-BED VAN; DRUMS <br /> t o o a <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) I <br /> DISPOSE OTHER <br /> REMARKS t7 SOIL <br /> Q CONSTRUCTION <br /> FACILITY PICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS C <br /> SIGNATURE O UT:,HORIZED/AGENT DACT <br /> 1. ❑ OIDD r <br /> �F il• "© ASH <br /> f ❑ SPECIAL OTHER l <br /> SCHEDULING'MU TBE MADIt PRIOF O 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL o ANY UNSCHEDULED LOADS ARE SUBJECT. <br /> TO REFUSAL UPON ARRIVAL.O�I OINC DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> 1 � <br /> Rev 11/09 NS-024 TRANSPORTER COPY MANIFEST#� x �. { <br />