Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill 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(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 WASTE ACCEPTANCE NO. <br /> L acffic Gas <br /> as rJ k 1.itV4lJ.li4 <br /> MAILING ADDRESS _ <br /> 77 Beale Street Mail Code B24 A Y7v.7 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ran F+1r�nrtrArCw C.A 94170 <br /> PHONE O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> - — LlTY-VEK ❑OTHER <br /> CON O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATVRE OF AUTHORIZED AGENT/TITLE DATE <br /> CAa�ttoriud Agent for gg <br /> Pecifi C3ea Electric �G�Lly�J .........._..... <br /> iZ1'tlile <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material is rat a hazardous <br /> waste as defined b 40 CFR Part 261 or title 22 of the Califomia code of r <br /> Y regulations,has been Property <br /> described,classified and packaged,and is in proper oondifion for transportation a cording to applicable <br /> regulations;AND,If the waste Is s treatment residue of•previously restricted hazardous waste <br /> subject to the land 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 lorWr a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> T nvrni cn""Unyc aicrr itcnuiun <br /> FiANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> to.Yr rtation <br /> ADDRESS <br /> 820 n este-Ct. <br /> CITY,STATE,ZIP <br /> Windsor, CA 19i492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGN IZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D UMS <br /> ❑ ❑ ❑ ❑ <br /> Z 5' <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 /> O <br /> EMARKS SOIL <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> :; :.,r.• O ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3;00 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 /> GENERATOR COPY MANIFEST# 3 419 n 5 <br />