Laserfiche WebLink
❑ Keller Canyon ❑ OX Mountain . ❑ Newby Island ']'Forward <br /> Sanitary Landfill . -Sanitary Landfill Sanitary Landfill Landfill <br /> 1301 Bailey Road 12310 San Mateo Roar! 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 (209) 982-4298 <br /> ` Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax (209) 982-1009 <br /> • <br /> NON-HAZARDOUS WASTE MANIFEST <br /> rGENERATOR WASTE ACCEPTANCE NO <br /> � r r '�� e" i <br /> MAILING ADDRESS Vr_ ' �t •e ' <br /> CITY, STATE, ZIP w # Z 14 r7' r ,"� � C�' REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> r' J 41 Q TY-VEK Q OTHER <br /> CONTACT PERSON /k j �' ,`�, ;s� �—.�",.,r -a <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous r <br /> waste as defined by 40 GFR Part 261 or title 22 of the California endo of regulations has been properly <br /> described classified and packaged and s in proper condition for transportation a-cording to applicable <br /> regulations AND It the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restnctions I cerlify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL ZI SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> Q DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> RANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> r <br /> ADDRESS L / <br /> _-1 <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> IN <br /> sf <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 o solL <br /> /0 CONSTRUCTION <br /> FACILITY TICKET NUMBER t-r= DEBRIS <br /> L Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT f I , DA'E ASBESTOS <br /> Q WOOD <br /> f Q ASH <br /> Q SPECIAL OTHER <br /> 1CHEDULING MUST BE MADE PRIORTO 3.00 P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> O REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST 9 2 R ()2 7 <br />