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r� <br /> r UB0b,i hON-HAZARDp(IrSbSpECtA� <br /> QC}� 1 I/��//�� �, WASTE & ASBESTOS,MANIFEST <br /> r n ,f•'r7.�� <br /> FORWARD INCOp,p <br /> 1' 99A9 Souda AustFn Read: ATE D <br /> t lAte".CA 85336 1 t9 wast chanerway DATE: l `� <br /> L 0htl;299_982;9298 fix:209-982-I009 SWrkton,CA 95206 <br /> r Resource Recovery 20 -982-¢298 t fafn brrkac 209-.966.4902 <br /> r Fax:209-166,1 7 r y� TRUCK LIC#: <br /> y CUSTOMER NO: C(' -. G- <br /> TRUC No.. Page 1 of <br /> � <br /> } �—. TRAILC-k LIC#:r � - <br /> 1 <br /> BILL TO: G�( I a <br /> 1 i+ Ln <br /> r i , SIZE yp8 oEscalprloh nrorEs <br /> :.t]REFUSE <br /> i� ® Q rnrsEATEn Woof) •- �-_� n.7o[ai <br /> j C� l7 SgyDG'E a Quanta[ <br /> RASBESTOS -- --� <br /> L) GROss 4 <br /> U NaN•FRiAB4C AS13J_STOS r <br /> D11Son. /5 <br /> C3 SOL TARE <br /> U STOCKPILE <br /> NET E <br /> 1 <br /> 2 TONS 1( <br /> Signed����•_ IN AM/PM (4e7 eFR 261 or a <br /> ny <br /> Rev 12.1e ,_ OUT 1 rlp1i <br /> ApIkAte regulations;ANb <br /> - AtVt l 019 rid tvarrant that lho waste t <br /> e erntnpgt�tiorTzet!14 a _ (-�L ' R 261, <br /> ! ll• nr on`le F'ditl ` - _. _ NS.50 -- <br /> I T17ANSppRi'EB G11 ertorator`com fetes fta-bn and Trail s oder co Y/ <br /> a•TrarrsportQrs Nnrree and ~ <br /> 4L Aridrvss: �i !I �/�5 '_ m Ietes Ilc-e' r.Date <br /> (� Cp� j �Y� 3VV <br /> IC Phone: (] Z 1-1.c� () I cd 0�_ c��'1C' 1 f O), Q(� � �C�S . <br /> IWY <br /> 14T C� <br /> N nae I$ir}t <br /> 111. 13ESTINAriof�t Sir nalu -1z- <br /> (Gen corrtplt�te Itla-c and Dtastination Slfe cott�l3leles Illd-g) <br /> a.t31sp sal Facifrty and�lto Address: g•bate <br /> tj1'1.,�4Y C' C.US <br /> 1`7 L EPA Nurr}bar d.blscre a <br /> 5•AvS ll P ncylrldicaftopsp�sce; <br /> U. w it Cry � <br /> I horbb cerlff that ihr#abnV�nAtorcrd_ platedal i} ac <br /> o best of Ill k ot <br /> }o�rted 1119 tor <br /> a forar <br /> e.Name ofAuthor#zed A onl Print Is here a e, <br /> Reotrrd <br /> IV. ASBESTOS (Gonpr4tar comple10 tn s IVa f and p <br /> -taro <br /> --� <br /> n Operator`s Narne.andAddress: pera(Or Coll1Q-IVB l bola <br /> C,Res <br /> ponstbte Agency Name and Address: <br /> t b.Phnree: <br /> f Q.3iitsclal I lorjdllny I's <br /> tructions'and Addrttonrii I Iforrr?aG❑n: <br /> d.phono: <br /> f❑ f rtablo Q Non-firiabfe <br /> 0 1 <br /> OPERATOR'S CERTIFICATION;I�heRr6by dectarti that the riable <br /> and era classified,P`0110f l narked and lallelecf/piecarde�"i enti <br /> are lrl is Cf <br /> 1 Nott- dpbfa <br /> natroil�rf goven,"nonial re uralions• n i-WIMAI etre$lily and becuratel <br /> ( 1 ill I esacts In pr6per rondfilon for trails ori rbad above[s shipping Hama i <br /> { p according to aY iho pre er <br /> _± O 1 Tial. -' ppll�abfa Internationai and <br /> f Na'flu and Title pr.- <br /> I '�perafar relays io In,camriany}rrf}icir owns teases operates. <br /> erat ura <br /> ranoyetion o}Qrallan or both p <br /> conlrois;orstrpotvil the facility bnfn i pAto <br /> REV 12/f0 g den}olished or rerfovnteit,or the tient <br /> otrlion or <br /> — --.----- RETUR4 TO GE•NEIZATOR <br />