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` 011/2$/2010 1.3:31 2099821803 i3ONADONNA ASHAPHALT PAGE 04/05 <br /> F 9 iil�' D I N G ORP RAT Forward <br /> 9WSduthAustim&id I145We. ... .torE DATE: .r. / f`. � <br /> Manteca,CA 95336: Soackxon,CA 95246 landfill <br /> Landoll'b9-982-429e Fax:209A82-!D09 Main Office!209-466-4492 9999 S.Aurstin Road <br /> Resourtc Recaveey;2a9.982.421a Fex:209.466 �A61 TRUCK LIC# ' Mant"It.CA 96336 <br /> } . <br /> 7 <br /> CUSTOMER NO.... .. � TRUCK NO: Phoma(209)992-4239 <br /> -_ _ _ TRAILER LIC#. Fax(209)982.1009 <br /> BILLT �. <br /> I :E NO, <br /> e Simy6 DESCRIPTION NOTE$ <br /> CT: <br /> VIE EQUIPMENT <br /> C�? TREAT D WOOD GROSS TOR o HARD HAT <br /> " u SLIJDGB Cl . <br /> ❑ASH <br /> o A&8l;3T0S '+ <br /> �71�vrt-FRrna�a ns��e-rte ,.�� �- t TARS <br /> NE <br /> e _ ❑SOIL , <br /> -• <br /> •. r <br /> fl <br /> 'r TONS <br /> IN AMiPM <br /> AMfPM <br /> Q DISPOSAL' 4 St;U[3GF <br /> i, ❑CONSTRUCTION O WOOD <br /> 3 ❑DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE . -.................. <br /> I GENERATING FA II"I'1'Y- <br /> `- SPOR'tTERNOT E: VEH€CLE I I ENa6 NtJMBI' i TRUCK NUMBER <br /> ADDRESS: F51LOS9, <br /> A CITY, STATE; 7IP <br /> PHONE END DUMP BOTTOM Dum TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OF(I)RIVER DATE ROLI<O. S FLAT-BED VAN.. 0RUMS° <br /> p ❑ Q ZI <br /> 1 <br /> , <br /> w <br /> I <br /> CUBIC YARDS; <br /> I;hereby certify that the above named material has b"rl: <br /> accepted and to the best of my knowled-YL%the foregoing <br /> iS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS Q SOIL <br /> 0 CONSTRUCTION <br /> FACILIT TICKET NUIMBER DEBRIS <br /> -- ❑ NON-FRIABLE <br /> SfC,iNR7LiRE.4I`-'AUTHQRIZF.[?,AGENT DATE - <br /> 0 WOOD, <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 0,141.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SU ECT <br /> TO REFUSAL UPON ARRIVAL,ONGOING IDAILY DELIVERIES MUST BE SOHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> Fiav 17!49 NS-OPAr �y/� <br /> GENERATOR COPY MANIFE6T#'31,�LJ t.1 <br />