Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Islana I._4,t-orwara <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 /> I ac-AA.0 :. o1b sJt s',sWa..Lif <br /> MAILING ADDRESS <br /> 77 Beale Sweet MA Code B24-A Z 7 V?-Y <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> N err, 1iil,inmfz,,a:)., f_ A '141 7.11 <br /> U GLOVES U GOGGLES ❑RESPIRATOR Q HARD HAT <br /> PHONE <br /> (415) 973-3773 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> (_irav SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> iA 'Cie; , Kf:r4 i(yl' <br /> r xific(+z.£w E7erts ir: ............ <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazarddus <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <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 /> 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 /> ❑DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> a rit>i'.k:(?Il _ fg'.:bV`r,"r.#L�➢5 L"Sti63F:Rit�Y6i <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS _ <br /> CITY,STATE,ZIP <br /> vvS1id(soi.,, I„ 91 9549-Z <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> x'7(3-7)8 1 g '7 ❑ ❑ <br /> SIGNATURE OF AUTHOF�IZIrD AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <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# :" Iw <br /> GENERATOR.COPY 4 1 , ;. a,, <br />