Laserfiche WebLink
■ <br /> [I Keller Canyon L] 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)45&9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> ctris <br /> MAUNf ADDRESS <br /> A., 14 <br /> i'.. <br /> eat;_ p A <br /> CITY SATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ft&ildscoCA 94120 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> 7 O TY-VEK O OTHER <br /> CONTACT PERSON <br /> RobeYt GraySPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUT ORIZED AGENT/ TLE DATE l j/dNz <br /> s <br /> GENERA R'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> -Fwaste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly, n9 <br /> described,classified and packaged,and is in proper condition for transportation a'cordi to applicable <br /> regulations AND,II1M waste Is a treatment residue of a previously restricted hazardous waste <br /> " subject-to the <br /> 'Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> � RECEIVING FACILITY <br /> accordance with with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined <br /> 46&R Part 261.. <br /> WASTE TYPE: <br /> ISPOSAL O SLUDGE <br /> O CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING,FACILITY <br /> 3h&yd rater 4�taiion LATHROP <br /> NSRDATER NOTESCENSE NUMBER TRUCK NUMBER <br /> I3enB Tr€►nsp�rta�sn — - <br /> ADDRESS <br /> :�� t�i?et�Be�te C�at't <br /> ,;STATE,ZIP <br /> 1-H <br /> PHONE END DUMP BOTTOM DUMP: TRANSFER <br /> ('707W S- 407 ❑ ❑ <br /> $IGNATLJKE QKAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 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 /> 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# 000121 Q <br />