Laserfiche WebLink
F :Keller Canyon ❑ Cix,.wountain ❑ Newby lalal, ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary !Landfill Landfill <br /> 901 Baileg Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> .Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)45b-9800 Phone(650)726-1819 Phone(408)945-2800 Phone (209)982-4298 <br /> l=ax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982.1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> k GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY;STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES U GOGGLES ❑ RESPIRATOR U HARD HAT <br /> PHONE <br /> O TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r F <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material Is not a hazardous <br /> waste as claimed by 40 CFR Part 261 or title 22 o1 the Calilornia code at regulations,has boon properly <br /> describad,classified and packaged,and Is In proper condition for transportation a-cording to appllcablo <br /> regulations;ANO,If the waste is a treatment rssldus of a previously restricted hazardous wi ste <br /> subject to the Lard Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and Is no!anger a hazardous waste as defined by <br /> 44 CFA Pan 261. <br /> WASTE TYPE: <br /> U DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> U DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP`-' <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF UTHORIZED AGENTO-R DRIVER DATE ROLL FF(S) 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 /> Q SOIL <br /> EMARKS Q CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AG ,NT--, DATE <br /> -, Q WOOD <br /> OSH <br /> p 9CIALOTHER <br /> r <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 /> MANIFEST 11 ' <br /> 60JE-RATOR('0PY <br />