Laserfiche WebLink
I ❑ Keller Canyon ❑ Ox Mountain ❑ Newby.-Island Forward <br /> Sanitary Landfill �r ''.itary`Ldhdfill Sanitary �ndfill Landfill <br /> 901 Bailey Road Ydi O;San Mateo Road 1601 Dixon ding 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 /> i <br /> GENERATOR--, WASTE ACCEPTANCE NO. <br /> MAILING AbDWFSS <br /> CITN,,S ATE-BJP X, k1_1REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑GOGGLES U RESPIRATOR ❑HARD HAT ; <br /> a <br /> I J ❑TY VEK U OTHER <br /> GQIVTACTPERSON .�, ._ � <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTl-108IZE0-AG- ENT/TITLE DATE <br /> GENERATOR'S L�•,ERT�ICATION:f h repy cgnity.fhat the.above named material is not a hazardous r <br /> r' .waste as dQffi try 410P R Part 261 ar�. 2 of the Caucrriia code of regulations,has been properly <br /> described;cc'7!a stied aid{d.packaged, is in p�r pW bondAon for transportation a-:cording to applicable <br /> e regulations;AND,ft the waste 13 a ereatment�a3Jdue o!a previously restricted hazardous waste <br /> - subject to the Land Disposal Restrictions,I cehityz d warrant that the waste has been Treated in ' ✓7 y <br /> _,-µ,. <br /> RECEIVING FACILITY <br /> � .. accordance with the�equir`ements of 40'CFR PaA 266 and is no longer a hazardous waste as defined by., .. <br /> �k 40 CFR Part 261. ° <br /> ".. WASTE TYPE <br /> At <br /> U CONSTRUCTION ❑WOOD -- <br /> ' U DEBRIS B OTHER <br /> O SPECIAL WASTE ;7 r <br /> I GENERATIN��Gtt FACILITY <br /> i` /�1'yf�-��Ck'.'t1��`-�.�.g ,�{�� .��1�G°'(i .:'�. �Ji �-•� t'` � rj �W ,n 5 <br /> TRANSPORTER <br /> NOTES:. vEI�iCL LICENSE NUMBER TRUCK NUMBER. <br /> �1`"' <br /> ADDRESS', <br /> CITY,STATE,.ZIP <br /> ,..� END DUMP==—BOIT0MDUMP - - TRANSFER <br /> PHONESIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE .: ROLL;rOFF(S) FLAT-BED ' VAN DRUMS <br /> )i.\ <br /> A <br /> i "tom / V <br /> CUBIC YARDS <br /> I <br /> - <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED.BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS Q CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER - _ J NON-FRIABLE <br /> r w ASBESTOS <br /> SIGNATURE OFAUTHORIZEUAGENT­-- DATE <br /> ❑WOOD72 _ <br /> r- - <br /> [7 ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE,PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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 /> TANSPORTER COPY MANIFEST# 4 4 4 l <br />