Laserfiche WebLink
Keller Canyon ❑ Coffin Butte ❑Ox Mountain El-Newby Island ®Forward <br /> Sia <br /> nitary'L.andfill 'Landfill ,.Sanitary Landfill Sanitary Landfill Landfill <br /> ._901 Bailey Road' 28972 Coffin Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsbu CA 94565 Corvallis, OR 97330 Half Moon Bay,CA 94419 Milpitas, CA 95035 Mariteca, CA 95336 <br /> Phone(92%46-9800 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 N0. <br /> Headwater Fieractt>u'xx� <br /> MAILING ADDRESS <br /> WO W,1iaZdtCn Ave — . <br /> 6939 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMEmzaNT <br /> MI . . <br /> PHONE GLOVES O GOGGLES U RESPIRATOR 'y HARD HAT <br /> 469-0625 U TY-VEK U SAFETY VEST <br /> CONTACT PERSON j <br /> Nat c6awn SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardpUs <br /> waste as defined by 40 CFR Part 261 or tills 22 of the California code of regulations,has been properly. _ <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations:AND,If the waste Is a treatment residue of a previously restricted hexardous weave <br /> subject to the hand Disposal Restrictions;I certify and warrant that the waste has been treated to RECEIVING FACILITY <br /> .accordance with the requirements of 40 CFR Part 266,and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261. <br /> k WASTE TYPE: <br /> ;6 DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2025 W Hazelton Ave STOC=oN' <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER ` <br /> W Truf ker <br /> ADDRESS 7 <br /> 271O Loomis Road <br /> CITY,STATE,ZIP <br /> PHONEEND DUMP BOTTOM DUMP : TRANSFER <br /> 209 456-114 p <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> :r CUBIC YARDS, <br /> l hereby certify that the,above named material has been <br /> accepted and to thebest-of my knowledge the foregoing DISPOSAL METHOD: (TO BE CO L c D BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> SOIL <br /> REMARKS <br /> U CONSTRUC710N <br /> FACILITY TICKET NUMBER DEBRIS <br /> . U NON-FRIABLE <br /> ASBESTOS ` <br /> SIGNATURE OF AUTHORIZED.AGENT DATE <br /> ❑WOOD <br /> U ASH <br /> *' U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 'IO REFUSAL UPON ARRIVAL. ONGOING DAILY, DELIVERIES MUST.BE.SCHEDULED WITH THE LANDFILLfHE DAYBEFORE. <br /> GIrNERATOFRrCopy, MANIFEST# 564-981. <br /> i,i,, <br />