Laserfiche WebLink
on F] Ox Mountain El Newby Island [ Forward <br /> Iapryv 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 P n�(20 )982-429,- <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 -' Fax 9) 82- 0 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Q GLOVES Q GOGGLES Q RESPIRATOR 0 HARD HAT <br /> Q TY VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SWA AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or fide 22 of the Calffomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a,00rding to applicable <br /> regulations;AND,If 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 /> With the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION O WOOD <br /> Q DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> ®RANSPORTER NOTES: 'VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> r <br /> rrl S A , <br /> P 9 END DUMP BOTTOM DUMP TRANSFER <br /> S A OF'AUTVORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DR MS <br /> CUBIC YARDS <br /> 1 (ereb certify that the above named material has been <br /> accepted and$O the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> A,$BESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> WOOD <br /> i� <br /> )Q ASH <br /> f '+ Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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 /> GENERATOR COPY MANIFEST# 372280 <br />