Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Salley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Haff Moon Bay, CA 94019 Milpitas, CA 95035 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 Fax (650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> dh NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CIT(, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ❑TY--VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> I GENERATOR S CERTIFICAMN I hereby certify that the above named material is not a hazardous M1 <br /> waste as defined by 40 CFR Part 261 or 4tle 22 of the California code of regulations has been property <br /> described classdled and packaged and is in proper conddion for transportation a-cording to apphrable <br /> regulations AND,It the waste is a treatment residue at s previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions 1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance 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 <br /> U DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br />' 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN RUMS <br /> ❑ ❑ ❑ ❑ <br /> i� <br /> CUBIC YARDS k <br /> I hereby certify that the above named material has been <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 /> DISPOSE OTHER <br /> FtEMARKS a SOIL <br /> I ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> C] NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> ' ❑ASH <br /> ❑ SPECIAL OTHER <br /> I SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> SALES COPY MANIFEST# <br />