Laserfiche WebLink
❑,Keller Canyon ❑Coffin Butte ❑Ox.Mountain El Newby Island [N Forward <br /> Sanitary Landfill Landfill Sanitary Landfill -Sanitary Landfill Landfill <br /> '901 Bailey Road 28972` offin Swye Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Piftsburg, CA 94565 Corvallis,OR 97330 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phone(925)458-9800 Phone(541)745 2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Hea�irlttcr'Rt�ltux� <br /> MAILING ADDRESS <br /> 6939 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> nodda4QA 95203 <br /> PHONE <br /> GLOVES 0 GOGGLES ❑RESPIRATOR )b HARD HAT <br /> 469.0625 ❑TY VEK ❑ SAFETY VEST <br /> CONTACT PERSON <br /> 1tt.C 11101] SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material Isnot a hazardous' <br /> waste as defined by 40 CFR Part 261 or fibs,22 of the Califomis code of regulations,has been properly.: <br /> described,classlfied and pardraged,and is In proper condition for transportation according 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,f cortity 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 /> I <br /> DISPOSAL ❑SLUDGE i <br /> ❑CONSTRUCTION ❑WOOD <br /> U DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W-HAzetton Ave STOCIMN <br /> TRANSPORTER NOTES: .VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> W.Trucker <br /> / <br /> ADDRESS to . <br /> 2710 Loxni!;Road <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (2 456,1145 ❑ <br /> SIGNAT FIE RAUTH2, D AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN D UMS <br /> l CUBIC YARDS I <br /> hereby certify that the above named material has been {rte • rj <br /> accepted and to the best of my knowledge the foregoing K, <br /> Is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILLj' <br /> DISPOSE OTHER. <br /> a'soiL . <br /> EMARKS: <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U,NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE QF AUTHO IZ D AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT I <br /> TO' REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE(�DAV BEFORE: <br /> GENERATOR COPY MANIFEST# f <br />