Laserfiche WebLink
❑ Keller Canyon ❑ C;,.Aouintain ❑ Newby Islah d ❑-Pdrward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailoy Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,r'A 94565 Half!Moon Bay,GA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> R Phone(925)458-9800 Phone(650)726;t 819 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 <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ <br /> CITY;'STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ' ' - U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> r -- ' _ 7� Q TY-VEK O OTHER <br /> C IV CT PERSON ' <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> -GENERATOR'S CERTIFICATION:I hereby certify that the above named material is nol a hazardous <br /> waste as dofined by 40 CFA Pan 261 or title 22 of the Celilomia code of regulations,has been property <br /> described,classified and packaged,and is in proper condition tnr oansponation a-cording to applicable <br /> regulations;AND.If lata waste is a treatment residue of a prevlously restricted hazardous wast* <br /> subject to the Land Oisposal Restriclions,I sonify and warrant that the waste has been healed In RECEIVING FACILITY <br /> accordance with the requirements of 46 CFR Pan 288 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> J-01SPOSAL Q SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> *DEBRIS C1 OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> i <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMB—ER—F TRUCK NUMBER <br /> A DRESS <br /> CITN;'STATE;ZIP F. <br /> ._..•-�,�^i �- a� 'fes"� <br /> PHONEEND DUMP BOTTOM DUMP TRANSFER <br /> SIGN T REO A THORI . D AGENT OR DRIVER DATE ROLL=OFF(S FLAT-BED VAN DRUMS <br /> a ❑ ❑ ❑ <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 ❑SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER i' DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURgOF AUTHOWCWED`AG�NT DATE <br /> . : O WOOD <br /> E rOAOH <br /> 4O SPECIAL.OTHER <br /> 73T BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> `N ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL.THE DAY.BEFORE. <br /> MANIFEsT#� ; <br /> GriJFf2A.l-t�R r:rlWv <br />