Laserfiche WebLink
+iy .F, l t .iA' ali xr lir ra*vrtr...+'7 � �l S '�n-d <br /> ry7 <br /> ,S'a F �c. A t � rIISl Q �w 3�R? n.,`d'j�y.�x� yr��'�` .�,nia Lt�` ��Y ^ � .r=y � Sanity L dfli Salitary Landfilll <br /> r.,5' '^s d f'--i .�sg ..�,v,� w gv 1 <br /> f r 90L Bagley F[oa[112310 San Mat Road ''s i60 flxon Landing Road 9999 S Austen Road <br /> p Plfi_66rg,CA 64565'P' Half Moon'Bay,CA 94019 Milpgasr GA 95035' i�Flanteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1 B19 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRES <br /> CITY, STATE, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE - UGLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> ❑TY-VEK a OTHER <br /> CONTACT PERSON <br /> r t SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> * 0 / <br /> GENERATOR S CERTIFICAl70N I hereby eeitty that the above named material is not a hazardous <br /> wash a s dehnad by 4p CFR Part 261 or title 22 01 the Celdomfa code of ragulatipns has been property <br /> described dassdled and packaged and is to proper condition for transportation d cordrng to appl cablg <br /> regulations AND,tf the waste is s treatment residue of a provtouely rodriotad hsrArdous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wdh the requirements of Q CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ER <br /> A SPECIAL WASTE <br /> GENERATING FACILITY <br /> ? L� <br /> nrtl"PORTERNOTESa 7417qJI :Z <br /> ICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ' 1 <br />]rPHO�NE <br /> ITATE, ZIP!g t <br /> END DUMP BOTTOM DUMP -' TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> 17 <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS _ ❑ SOIL <br /> O CONSTRUCTION <br /> FACILITYTI ETNUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGN A R UTH RIZEP AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> O SPECEAL OTHER <br /> SCHEDUUN 3 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 /> MANIFEST#t 434,94 <br /> tel:MPRATOR C.C)PV : <br />