Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary.Landfill J` 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-HAZARDOUS WASTE MANIFEST <br /> r s <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> A.Otin111.0\3Q.7 t%.' 1•'144t110 <br /> j'R. <br /> MAILING ADDRESS, A?1,A <br /> 77 Beale Street Mail Code B24A <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> z <br /> 80-n °?ncr O, CA -L- U GLOVES O GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON ' <br /> RobeI't SPECIAL HANDLING PROCEDURES: <br /> t` SIGNATURE OF AUTH RIZED AG NT/T DATE <br /> i GENERATOR$CER FICATION:1 hereby nity,that the above named material is not a hazardous <br /> wagte. c dejsted 4y 40 CFR Part 261 or title 22 of the California code o1 regulations,has been properly <br /> a1 descried dassrfiea and packaged,and is in proper condition for transportation according to applicable _ <br /> r; regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> suble�i to the Land Dtsposal,Restrictions,.I certify and warrant that the waste has been treated in REC4VING FACILITY - • <br /> 'accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> y: 40 CFR Part 261. - -- <br /> WASTE TYPE: •� <br /> -0" DISPOSAL ❑SLUDGE •)♦ <br /> U CONSTRUCTION U WOOD <br /> €F U DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY •� <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER ' <br /> _Ts19.3,5•C?O. ..c't till -- - - <br /> <br /> . <br /> ADDRESS . <br /> CITY,STATE,ZIP <br /> jj <br /> indsaz CA 95492. <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 0-r ❑ ❑ <br /> SIGNA UR OF A RIZED AGENT OR DRIVER DATE <br /> ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> fS40 <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 /> WE-MARKS <br /> U CONSTRUCTION <br /> �" <br /> [FACILITY DEBRIS TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO 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 /> r_PNir RATnR rnPV MANIFEST# n n A A A n <br />