Laserfiche WebLink
❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island r Forward <br /> 3 f Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999.5.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 /> x: 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 /> MAILING ADDRESS <br /> beaj,etArett 1-01W S- "B24A 431-4 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San.k ra.�cis:o, A 94120 Q GLOVES U GOGGLES O RESPIRATOR D HARD HAT <br /> _ PHONE <br /> -' Q TY-VEK U OTHER <br /> CONTACT_PERSON <br /> Robed — SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION.I herebyt the above narned material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22cert f California code of regulations,has been property - <br /> described,classified and packaged,and is in pr r condition for transportation aiding to applicable - <br /> regulaiii s;AND,if the waste Is a treatment residue of s 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 /> ISPOSAL U SLUDGE <br /> CONSTRUCTION Q WOOD <br /> Ll DEBRIS U OTHER <br /> L]SPECIAL WASTE <br /> GENERATING FACILITY <br /> { i stku I)e$nrtc>s utst%r,�c LA'T13-RO2 <br /> AANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> <br /> <br /> � <br /> 7; 820 Dezn$43tf Cax.irt — — <br /> CITY, STATE,ZIP <br /> WiU&OfCA4�2 ----— <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)838-1407 0 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL OFFS) FLAT-BED VAN DRUMS <br /> l , ❑ ❑ ❑ ❑ <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 /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO3:00 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# 0 0(Z C 7 0 <br />