Laserfiche WebLink
EI'Keller Canyon ❑ Ox Mountain ❑ Newby IslandForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> ws y*� d 1231asan;Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> P� 5 Half Moon Bay,CA'94019 Milpitas;CA 95035 Manteca;CA 95336 <br /> =9800 Phone(650),726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax. Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> >' NON-HAZARDOUS WASTE MANIFpt <br /> r� <br /> GENERATOR _ WASTE ACCEPTANCE NO. <br /> Tack Gas&F3o_tciz <br /> :'- MAILING ADDRESS <br /> T- B",it '4S>'CCt I rYiZlt n= TF3i24 <br /> 4314 <br /> CITY,;STATE,ZIP _ _ _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 8Ht Francisco,CA 94120 <br /> PHONE --- -- U GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> 4t4 as' ;a-3773 - - - - O TY-VEK U OTHER <br /> CONTACT PERSON <br /> xc t Gra SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORI ED AGENT/TITLE DATE <br /> * s rs 4) <br /> GENERATOR'S CERTIFICATION:I hereby=that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Califomia 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,It the waste Is a treefinent residue of a previously,reshicted-hazardous waste <br /> subject to the land Disposal Restrictions.i certify and warrant that the waste has been treated'm RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is noloriger a hazardous waste as defined by - - - <br /> 40 CFR Part 261. - <br /> WASTE TYPE: <br /> -III-DISPOSAL 0 SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> I_J DEBRIS I_]OTHER <br /> J SPECIAL WASTE <br /> GENERATING FACILITY <br /> Lala t op T)�ydrxteT S icz LATS{)1' -— <br /> r RAN NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> T3 ;erste Tratopmtafiva - <br /> ADDRESS � <br /> <br /> CITY,STATE,ZIP - - - - - 6A, <br /> W ,CA 95492 _ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 70? 838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 1DRUMS <br /> ❑ ❑ ❑ ❑ <br /> ih& <br /> t' CUBIC YARDS <br /> I.hereby certify,that the above named material has been <br /> accepted and to the best of my.kriowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER •� <br /> t U SOIL <br /> EMARKS <br /> U CONSTRUCTION • <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE �� <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE •� <br /> U WOOD <br /> U ASH •� <br /> U 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# ^n n r^ r- <br />