Laserfiche WebLink
s I II Chi yoll I Coffin Bub. Ox MOUntain Newly- Island <br /> y Forward <br /> onit ; <br /> Landfill <br /> Niq 8W P607p,coffin 1]-1111 000 1911110 Ran Mlm'o Road I,Cl Kon 1,t1ndpo nond 0000 &.4 I � ani <br /> G.. . 4 4 v..il..I � l i..if Mw pql 0� voig Milp!w'! CA 0,94 Mnn(09, AIa��c <br /> Phone (925)458-9800 Phone (541) 745-2018 Phone (850) 726-1819; Phone(409) 945-2800 Phone (209)982-4298 <br /> Fax(925) 458-9891 Fax(541)745-3826 Fax(650) 72679183. Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> . i <br /> GENERATOR WASTE ACCEPTANCE N.O. <br /> MAILING ADDRESS' <br /> 20509ov*Holly Drive 9905 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 7r � CKGLOVES ❑ GOGGLES ❑ RESPIRATOR M HARD HAT <br /> PHONE . <br /> 7 9 i>w ❑TY-VEK CXSAFETY VEST i <br /> CONTACT PERSON <br /> Anne-PM SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT[TITLE .. DATE <br /> GENERATOR'S'CEAT{FICATION:I hereby certity,that the above named material is not a hazardaus <br /> waste as defined by 40;CFR Part261 or title 22 of the California code of regulations,,has been properly <br /> r described,cfassified and pac&adcd,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 RRestrictions,i certify and warr_an!that the waste has been treated in RECEIVING FACILITY ' <br /> I accordance with the requirements of 40 CFR Part 268 and is nolonger a'hazardous waste as defined by. <br /> 40 CFR Part 261 <br /> WA <br /> O CONSTRUCTION ❑WOODG'1 m <br /> f ❑DEBRIS ..x ❑OTHER <br /> ? ❑SPECIAL WASTE <br /> GENERATING FACILITY' <br /> 2015W Soul HOW DriFe TRACY <br /> TRANSPORTER NOTES:. VEHICLE LICENSE NUMBER TRUCK-NUMBER <br /> jail '�' <br /> ADDRESS <br /> CITY,STATE,-ZIP n..; <br /> i4 9581 -.-- — -- TRAN <br /> - PHONE `. -€? --- BOTTOM_DUMI?_. SFER. <br /> Ll <br /> SIGNATURE:OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS I <br /> I hereby certify that the above named material has been14 <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 /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> DEBRIS <br /> F `CILITY TICKET.NUMBER ❑ NON-FRIABLE <br /> ASBESTOS <br /> j <br /> SIGNATURE OF AUTHORIZED% ENT ATE. <br /> F ❑ )OD <br /> ' f /r •�+ SH i <br /> x <br /> ECIAL OTAR ? <br /> }}IEE - � l � .,.. ❑-SP -. <br /> 1 F <br /> SCHEDULING MUST BE MADE P $O�i,T+D 3:00 P:M.TFIE DAY PRIOR TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL LiPO1V ARRIVAL AIGOING DAILY DELIVERIES MUST BE SCHEDULEDWITH THE LANDFILe-fiA=DAY'BEFORE. <br /> 41, <br /> Rev 11/09 N5-024 TRANSPORTER COPY MANIFEST# '�-� <br /> _. Ns. <br />