Laserfiche WebLink
❑ Keller Canyon <br />Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />El Coffin Butte <br />Landfill <br />28972 Coffin Butte Road <br />ConrdDis, OR 97330 <br />Phone (541) 745-2018 <br />Fax (541) 745-3826 <br />Sanitary Landfill <br />12310 San Mateo Road <br />Hag Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />is <br />El Newby Island <br />Sanitary Landfill <br />1601 Dixon Landing Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <br />Fax (408) 262-2871 <br />KI Forward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERAT,QR <br />WASTE ACCEPTANCE NO. <br />Fu joaquiti, county of <br />f�AlLtNG ADDRESS <br />_ 6881 <br />le - <br />G ITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />GLOVES U GOGGLES U RESPIRATOR X U HARD HAT <br />O TY VEK �] SAFETY VEST <br />PHONE <br />`209 468-3066 <br />CONTACT PERSON <br />C <br />SPECIAL HANDLING PROCEDURES: <br />r€ONlme erez <br />ur <br />SIGNATU OF AUTHORIZED AGENT / TITLE DATE <br />r f - e <br />TORS CERTWICATION: I bar tud tte above named rnaterial is not a hazardous <br />as defined by 40 CFR Part 261 of We 22 of the CaMornia cods of regulations, has been property <br />describsel. classified and padaged. and is in proper conditbn for transportation a-cordng to applicable <br />Aft, N the waste Is a treabnerd residua of a previously restrided hemrdwrs waste <br />U4901 to the Lard ousel Restrictions, I and warrent fret lire waste has been treated in <br />accordanos with tie reqarements of 4o CFR Part 268 and W no longer a hazardow waste as defined by <br />40 CFR Part 261. <br />RECEIVING FACILITY <br />I t 11.r 1 r if ! ffi <br />WASTE TYPE: <br />f 19 t,GPt r 0 <br />O DISPOSAL U SLUDGE <br />U CONSTRUCTION U WOOD <br />U DEBRIS U OTHER <br />U SPECIAL WASTE <br />rr ; f f r frr t t, : C" - <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />efta Container crp <br />L/ 5111 <br />ADDRESS <br />1143 NVQ r1,Cr" Way <br />CITY, STATE, ZIP <br />oluon,t-7773210(7 <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br />ROLL -OFFS FLAT-BED VAN DRUMS <br />,• <br />I hereby certify that the above named material has been <br />accepted and to the best of my knowledge the foregoing <br />is true and accyrate. <br />6 ❑ ❑ ❑ <br />CUBIC YARDS <br />� J ' <br />AL <br />DISPOSAL METHOD_(TO BE COMPLETED bY LANDFILL) <br />DISPOSE OTHER <br />64—/Soll- <br />•CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />U NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT DATE <br />U WOOD <br />U ASH <br />U SPECIAL OTHER <br />ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br />SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />GENERATOR CORY MANIFEST R Crs F" 0 <br />