Laserfiche WebLink
❑ Keller Canyor4, i „ ❑ Ox Mountain <br /> ❑ Newby island [4,Forward <br /> Sanitary Landfitl Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey 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) 458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(2Q9) 982- <br /> Fax (925)458-9891 Fax(650)726-9183 Fax(408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> ME GENERATOR '� IFi <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ <br /> CITY, STATE,ZIP t ; c j =� FREQUIREDPERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES ©GOGGLES d RESPIRATOR U HARD HAT <br /> U TY VEIL O OTHER <br /> CONTACT PERSON - <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named rnatenal is not a hazardous <br /> waste 8s defined by 40 CFR Part 261 or title 22 of the California coda of regulations has been properly <br /> deacrrbed cfa3siTistl and packaged and is in proper condition for transportation a cording to apphcahle <br /> regulations AND,It the waste I$s treatment rbsidus of a pmluualy raotrktad hasardoas walls <br /> subject to the Land Disposal Restricrtona I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and Is no ionger a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261 - <br /> WASTE TYPE <br /> ©DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD ' <br /> U DEBRIS 't�OTHER <br /> U SPECIAL WASTE <br /> GENERATING FAC LITY - <br /> �p1P <br /> TRANSPORTER 3w { t NOTES VEHICLE LICENSE NUMBED TRUCK NUMBER <br /> ADDRESSt. f r� [ t t w <br /> CITY,STATE,ZIP <br /> PHONE , <br /> END DUMP BOTTOM DUMP._ TRANSFER <br /> SIGNATURE OF-/-. ORIZED <br /> APIyNT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DDRUMS <br /> _ y o <br /> Ll <br /> CUBIC YARDS <br /> I hereby certify that the above named material has beery_ <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 /> REMARKS ❑SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE RFAUTHORIZEDAGENT DATE ASBESTOS <br /> U WOOD <br /> 1 ' <br /> , <br /> V ASH <br /> ❑SPECIAL OTHER <br /> r <br /> SCHEDULING MUST BE MARIORTO 3 OO P M THE DAY PRIORTO 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 /> - ---- A -W e'�'ri 0`A <br />