Laserfiche WebLink
Keller Oanyop ❑ Ox Mountain ❑ Newby island `,®forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90.1',Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg, CA 94565 Halt 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) 982-100 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ,''t WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ll GLOVES a GOGGLES a RESPIRATOR 0 HARD HAT <br /> PHONE , <br /> Lk TY VEK ❑OTHER <br /> CONTACT PERSON v <br /> �,�, c".. >�, fi' ���r,✓,j, � ��,..- ,�� SPECIAL HANDLING PROCEDURES -- -- <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE - <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 btle 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND N the waste is a treatment maidue of a previously restrkled hazardous waste <br /> subiect to the Land Disposal Restrictions I 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 CPR Part 261 r <br /> WASTE TYPE <br /> O DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ~ L7dl }iER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY _r <br /> TRANSPORTER ,• „ -- j r x NOTES VEHICLE LICENSE NUMBER TRUCKNUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> --- PHONE — — -- END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUT R3Z-ED AGENT OA DRIVER DATE ROLLOFF(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 /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> —1 ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT° DATE <br /> ❑WOOD <br /> ^� ❑ASH <br /> a, ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 IPM THE DAY ARIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARIE StUBJE <br /> T€3 REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST 13E SCHEDULED WITH THE LANDFILL THE DAY ISE FOR <br /> MANIFEST # 43676 <br />