Laserfiche WebLink
❑ Keller ra,nyon ❑ Ox Mountain ❑ Newby Island ;LSF Forward <br /> ganitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> ' Pittsburg,CA 94565 Half Moon Say CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phc�e(925) 458-9800 Phone (650) 726-1819 Phone (406) 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~- - �a *, ' ' — z' -r- . WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ;' _' -� , _ ( r 1 _ l J fr J <br /> , ,- <br /> r <br /> CITY, STATE, ZIP,-- - REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> f <br /> GENERATOR S CERTIFICATION E hereby cartify that the above named matorW is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code o1 regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND it 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 RECEIVING FACILITY " <br /> accordance w4h the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> AD CFR Part 261 <br /> WASTE TYPE <br /> a DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> •DEBRIS ''OTHER <br /> U SPECIAL WASTE l <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ,} T �•' s ' ' <br /> r <br /> CITY, STATE, ZIP -7 <br /> PHONE Ljt 1 _� 07, c -- END DUMP BOTTOM DUMP TRANSFER <br /> f ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <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 /> Is true and accurate <br /> tf DISPOSE OTHER <br /> �l SOIL <br /> EMARKS ' `-- <br /> � O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ° ❑ DEBRIS NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT] ~� f ! DATE <br /> r ❑WOOD <br /> { O ASH <br /> i , <br /> ' O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 fl0 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> To REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY gBEFORE <br /> MANIFEST# t <br />