Laserfiche WebLink
' hita"canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> ry 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 'J� l=ax(209) 82-1009, <br /> NON-HAZARDOUS WASTE MANIFESTGENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ' <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> PH <br /> U TY VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> §iWAftAnF <br /> AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS CERTIFICATION.I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tide 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,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 /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> U DISPOSAL U SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> i','-i "maxAn,.l K <br /> NSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> CI -T <br /> P END DUMP BOTTOM DUMP TRANSFER <br /> AUTHORIZED AGENT OR DRIVERDATE ROLL-OFFS) FLAT-BED VAN DRUMS IOUAMAIF CW <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 <br /> EMARKS SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHQRIZED AGENT DATE <br /> 1 ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> HEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 372278 <br />