Laserfiche WebLink
�� I\GIIG! vCilrl Vl, VI. 1e1VV11LG111 —_i 11GYe US 131cx11V ` . � ' Ys014 <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road Jk 10 San Mateo Roac 1601 Dixor 16tiding Roac 9999 S.Austin Road <br /> Isis, Pittsburg,CA 94565 ?*1f Moon Bay, CA 9401 c Milpitas,CA�03E 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> ` MAILING ADDRESS <br /> CITY, STATE,ZIP^ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ... - - 0 GLOVES ❑GOGGLES 0 RESPIRATOR O.HARD HAT <br /> PHONE <br /> -"" 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE , DATE <br /> GENERATOR'S ARTIFICATION:I hereby certify trial Va above named material is not a hasardcus <br /> waste as defined by 40 CFR Part 261 w title 22 of the California code of regulations,hes been PIOPVM <br /> described,deasifisd end pac ged,and Is In Proper cwdildn for tninspprlatmn az rdag b applicable <br /> regulatgns;AND.X Vie waste Is a trYbllsnt Ipldlw of a pra'Asualy neatrkted lasardous wash <br /> subjx to dw Lard Disposal Reatriclbra,I ceVVy and warrant Vat the waste has been trealed in RECEIVING FACILITY <br /> axwdanca wiM Va requirements of 40 CFR Pan 266 and is rw Iwger a l ardous waste As defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> W <br /> ... -0ISPOSAL O SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> _ ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> .. GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> u <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> MARKS 0 SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> 0 ASH <br /> r n 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAYPRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ITO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> = GENERATOR COPY MANIFEST M 22611 <br />