Laserfiche WebLink
-❑ Keller Canyon - ❑ Ox Mountain ❑ Newby Island �-Q Forward <br /> SgnIlta1y.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 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 /> NON-HAZAFRDOUTWASTE MANIFEST <br /> GENERATORj-- , ! i <br /> a ;x- ' , , � �, ` �, ,F f, ,' WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS,, <br /> � f r <br /> CITY, STATE, ZIP_ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> JEUPHONE <br /> D GLOVES ❑GOGGLES ❑RESPIRATOR ❑ HARD HAT <br /> ❑TY VEK O OTHER <br /> CONTACT PERSON ' �., ,, � , , ,, rf <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE ~ <br /> tGCNERATOR$CERTIFICATION I hereby certtify that the above named material rs not a hazardous ! <br /> ste as define¢by 40 CFR Part 261 or title 22 of ttre Catdomia code of regulations has teen property <br /> cribed classified and packaged and is in proper condthon for transportation a,Gordmg to applicable <br /> ulations ANO,It the waste la a treatrsont residue of s previously restricte i hsrardous waste <br /> ject to the Land Disposal Restrictions I certry and warrard that the waste has been treated in RECEIVING FACILITY <br /> ordance with the requirements of 40 CFR Part 268 ands no longer a hazardous waste as defined by <br /> CFR Par!261 <br /> UWASTE TYPE <br /> DISPOSAL O SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> DEBRIS Tl�ER <br /> SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> F f <br /> CITY, STATE,ZIP <br /> 7 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <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 beat of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED 13Y LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> t <br /> SIGNATURE QF AUTHORIZED AGENT DATE ASBESTOS <br /> \ ❑WOOD <br /> 1 I O ASH <br /> Q SPECIAL OTHER <br /> HIEDULING MUST BE MA PRIORTO 3.00 P fA.T'HiE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LADS ARE SUBJECT <br /> O REFUSAL UPON ARRI L ONGOING DALLY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL. THE DAY BEFORE <br /> �_` MANIFPgT t+ A 1°6 r%A s�L <br />