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Ma r, 11. 2008 3:18PM FORWARD 1NGII'sr 4a`Y011 I Kollin Butle I Ox Mountain I I Newby Island INQ, 9129ird K 10 <br /> sanitary)_andflll Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> OD L 0111ICY flood Afav(YAM @bile Road 12310 San MRIUQ Road MAN Inxr)n Landhg Road 9694 S.Aue11n Ruud <br /> PI=L rg,CA H4,.,er, c4mila,OR 9T9y0 Half MDon Bay,CA 114111H MIIpRM,CA 95wr, Metduua,CA 08336 <br /> Rhone(s25)4;0.6000 Plum(44 1)7461.016 rhona(rihfl)7v(I.1819 Phunr(405)946-1800 PhOM(21JU)GN2-42913 <br /> Fux(927)458-98g I RIX(bill)!4h MM rax(050)7299169 Rvc(406)262-2871 I nx(YfrB)882.1 OOB <br /> NOWHAMFIDOUS WAVE I+I AKIFEW <br /> OENERATpR WASTE ACCB"AME NO. <br /> MAILING DDRESS <br /> 140W 749/ `f5 <br /> CITY.STATE ZIP R PROTE <br /> PHONE - OtGLnvF:, U GOCiaLES 0 RESPIRATOR M HARD NAT <br /> U TY•VEK 1X5AFETY VEST <br /> CONTACT - <br /> - 31'1=CIAL HANDLING PROGEDURE$� <br /> SIGNATU E AUTHORIZE AGtNrlTITLE DAT <br /> 35546MIUS I CUMFICATION:I hw6—lv •MrNs nNwJ nwW�Ll6 nate hajr O . <br /> M".041.1-J Vr 16 Cell 0Mu Nbe Jl CdeaMla CCs.d n�„iwllnn.F.6 fVe111N.Q.a <br /> d.wb.d,eluih.d.4l..d,.p n.nrG a:I r I.nwap•,q.oenopprwllpn aWrainA b0001peoY <br /> .=BukIts AHG Ir the erne It a w4mvnt rrWee of 11)wI—ir..triol 6.ardouj move <br /> 1�.d..Luis 1511 p..l MOPAVIUM 1-4 mm wawim MAI fhb wane nee MB)tru16J i. RECEIVING FACILITY <br /> AIMUM.wbn We MOM.".140 CPA P..W w If nn ionger a ft u oO Uf wwa at 4ohnod try <br /> 10 CfR 2211 1.f 1. - -- <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE _ <br /> CONSTRUCTION U WOOD _ <br /> U DEBRIS U O 1 HLH --' <br /> O SPFrIAL WASTE <br /> GENFRATING FACILIIY <br /> 9570 East Minor Avaxie Sl OCtCCfjpf -- _ - <br /> AN PORTER VEHICLE LICENSE NUMBER TRU <br /> ADDRESS$ <br /> CI ATE, <br /> ft'NE ND DUMP BOTTOM DUMP TRANSFER <br /> -.-FAUTK7VZMAC4Nt OR DRIVER DATE FF(6) FIAT-BED VAN RUMS <br /> ❑ ❑ <br /> IJBIC YARD <br /> I hereby certify that tho above named material has been <br /> nonegtod and to the Best of my knowiad90 the foregotng <br /> Is true and accurate. D19P08AL MiTHOD: (TO 9E COMPLETED 8Y LANDFILL) <br /> DISPOSE OTHER <br /> MAK U SOIL <br /> O CONSTRUCTION <br /> A IL rAY TOX ET NUMB R DE_oRIS <br /> O FRWaLP <br /> SI RE AUTHO IZE AGENT E 68EBTOS <br /> ❑WOOD <br /> O ASH <br /> UyPECIALOTHER ...._ <br /> SCHKPUUNCI#UST 111k IRADE PRI TO 9:00 .11.Tt{E DAY ORTO EXPIMED AI1RIVAL.ANY UNSCHEDULED LOADS ARE SUUJKCT <br /> TOR 6AL PON ARRIVAL.ONOOINU DAILY DELIVRIEB MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> LANDFILL COPY MANIPEBT N 637940 <br />