Laserfiche WebLink
m ,, ❑ Leiter Canyon ❑ 0 €.Aountain ❑ Newby Isle ❑+brward <br /> Sanitary !Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901.Baifey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin R <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 953 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982- <br /> Fax (925)458-9891 Fax(650) 726-9183 Fax(408)2_62-2871 Fax(209)982-100 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> '()t�j,ij.,,y..'7;,. :-_ ,„;•"t�.r'i � �•% ?' ,'`ria'-k4~��F'. <br /> PHONE ' ✓ 0 GLOVES G GOGGLES ❑RESPIRATOR Q HARD!IAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON — <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S GERTIFfCAT1ON:I hdreby certify that the above named malarial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or 0%22 of the 6alitornia 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 residua 61 a previously restricted hazardous waste <br /> subject Io the Land Disposal Restrictions,I certity and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazafdotrs waste as dalined by j <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> U-D7 SPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> Q DEBRIS 0 OTHER <br /> L]SPECIAL WASTE <br /> GENERATING FACILITY <br /> t'-:r';f/f r�.G. .•� �Vit-f /._.�i�`Ir(i== I i'!%�'i� /'.!i ' <br /> r <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADD ESS <br /> 9...-m J_`1 'fir' 4. . 11 <br /> CITY,,SITATE,ZIP <br /> PHONE' END DUMP BOTTOM DUMP TRANSFER <br /> cf <br /> SIGNATURE OF AUTHORIZED-A ENT OR DRIVER DATE ROLLOFF 5 FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I 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 /> EMARKS 0 SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS, <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT` JDATE <br /> OODJWAASH <br /> f <br /> f].'SP,E IA!'OTHER <br /> SCHEDULING MUST BE MADE-PRIORTO3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> .TO.REFUSAL UPON ARRIVAL.:ONGOINGDAILY DELIVERIES MUST:BE-SCHEDULED WITH:THE:LANDFILL':THEDAY•BEFORE..-: <br /> MANIFEST M 7 1,;Q a� <br /> n�:rr❑r>nrna rnn.. <br />