Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑, 4ewby Island D� Forward <br /> Sanitary Landfill Sanitary Landfill - Sanitary Landfill Landfill <br /> 901(Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Ittsir9, CA 94565 Halt 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> k t <br /> MAILING ADDRESS !54 <br /> CITY, <br /> 1r `� <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE '.]"GLOVES U GOGGLES ❑ RESPIRATOR 31-LARD HAT <br /> U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNAT URE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERM;T S CERTIFICATION I hereby certify that the above named material s not a hazardous <br /> waste as defined by 40 CFR Patt 261 or Utie 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,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Drsposal Restrictions I certify and warrant that the waste has been treated m RECEIVING FACILITY <br /> accordance with the repLurements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> U CONSTRUCTION D WOOD <br /> U DEBRIS D OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> " / <br /> ADDRESS �ti'v <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFFR— <br /> D ❑ <br /> SIGNATURE OFAUTHORLZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 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 /> D SOIL <br /> REMARKS <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> * 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 /> SAES COP'f MANIFEST# 35860 <br />