Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island orward <br /> Satlit "pi�df t 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 /> ..0 •C <br /> MAILING ADDRESS <br /> 909 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a>ro F r. r. f 94120 ❑GLOVES 0 GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> 0 TY-VEK 0 OTHER <br /> CON O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OrAUTHORIZED AGENT/TITLE DATE <br /> i11-1,4_1............... <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous lone <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste is a treatment residue of a 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 /> acoordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> CONSTRUCTION a WOOD <br /> O DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> n,urnton 1_ -dt0r 17►orntvn <br /> RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> f)cneste � ra rtatlon ' r-k— <br /> ADDRESS <br /> 920 este Q. <br /> CITY,STATE,ZIP <br /> 1AAn r CA 95492 <br /> PHONE END DUMP _BQTTOfvi,t)UMIa "TRANS ER <br /> Lj <br /> SIGNATUR94F­AFJX4ORIZED A ENT OR DRIVER DATE ROLL-OFF(S) FLAT�BE VAN R <br /> ❑ ❑ ❑ . <br /> CUBIC YARDS <br /> 1 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 /> REMARKS ❑SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D WOOD <br /> U ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a 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# 341957 <br />