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�j Keller Carryon []coffin Butte ❑l Oi`Mounitaln ❑Newby Island 2rForward <br /> Sanitary`LaiiIdfi1l La ill a >iltary Landfill' Sanitary Landfill Landfill <br /> 9111"lay Road 26872 Coffin Butte Road 12390 sio maiao Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Piftburg,CA 24503 CotvAft,OR 97330 Hfllif Mahn any,CA 941015 %tiipibm,CA 95035 Manteca,CA 95339 <br /> Phone(925)458-9800 Phare(641)745.2019 Phone(asq-72&-18s 9 Phone WS)NS-2800 Phone 52091982-4�?98 <br /> Fax(925)456-9891 Fax(541)743-3826 Fix MM.728-9183 rax(408)202.2871 Fa,x(209)882-1009 <br /> NON-HAZARDOUS WAStE MANIFEST <br /> GENEBAATOR � . ' �iM a A WASTE ACCEPTANCE NQ <br /> MAILING AD ESS g � <br /> CITY,STATE.Zip 3 D REQV;R Cl PERSONAL PROTE V EQUIPMENT, <br /> Q GLOVES D GOGGLES CI R 1 R LARD HMT <br /> PHONE - J $ ft [►.S�r <br /> 0 TY VEK YSAFETY VEST <br /> Ca.2�, <br /> CONTACT PERSON IYA I•C q -7'0UAJQ <br /> SP ECIAL!•'>!ANDLINd PROCEDURES: <br /> SIGNATURE 01--AV IZEDAGENTrTLTLE I DATE <br /> 7 <br /> a�J+Ea:GtOp'S c¢RnfncAnoff:I Aerebr alrfhv me thwahava named melefiel qr not�nwwrdaux <br /> et ledtmW tq W CPR Pnn 261 u NIM 2i 0 tA!C40kmis code of rep MSMle.As!r4bW <br /> prOprMW <br /> bad,del�ied WO pupae,Mrd In h M,Aft*OWORIW fMefiWMflyn 9-aw np to epp�leal�9 <br /> rpgaladoM;AND,R ftWa to Is 4"O"M nnldt*of a p V*WAW MIVWW tl"r&to W"% <br /> IUW,o m the Lxd 01WO1al Ran,4erlone,I earey w,d wW"mac Mewdsl!nae bean 6ee,ad h ' ' RECEIVING FACILF Y <br /> eceora*F4*wean zea an <br /> h the roqulrvwtn of d0 CFR vd ti M longer d hazmd"o tet"a deBne6 by <br /> eDCFRPe�126t. ' <br /> WASTE TYPE: I-e,vD r i <br /> Q DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION a WOOD Q;1 CQ <br /> O DEBRIS G OTHER <br /> ASPECIAL WASTE <br /> C,ENERATING FACILITY <br /> &r ,•,i.4er Rd 54c 4A 64 /,f <br /> TRANS PORT R / Cit v a' IViDTEB VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ` A 17RE59 � y <br /> LLA <br /> CIN.STATE,ZIP Ej> <br /> PHONE -/ ? END DUMP BOTTOM DUMP TRANSFER <br /> -IGNATURE OF AUTHORIZED AGENT OR DRIVER [SATE ROLL-OFF(S) FLAT-BED VAN DAUM$ <br /> CUSIG.YARCIS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL MErHoo- (TCR BE GO WLE7'ED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> Q SOIL <br /> a, MARKS O CONSTRUCTIaN <br /> !� <br /> DEBRIS <br /> FACtLITYTICKET NUMBER Q NON-FRIABLE <br /> ASBESTOS <br /> SnNATURE Of AUTHORIZED AGENT OATS [a w0ce <br /> f�,.! ASH <br /> G$PEGIIsL WHEN <br /> 3CH AIILIPIj muW Be MA17E STD a;00 P.#I.TFiB s Pw10 D MOECY A ARRWL*ANY WALED LC7iliiD'$ARE SUBJECT <br /> To REFUSAL IL UPON ARRIVAL. OI!lGOM I)AILY DELVtES fMJST W ECHEDI IL.E!D WITH THE LANDMILL,THE 0 <br /> GENERA-ron copy MAAlIFESr s 6�w,..5?• <br />