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vvi r_v .v v.�.—rva;. �+ry s.vvJ �.i�vy.... .,•.• <br /> ❑ Keller Canyon ❑ C 'Mountain ❑ Newby Islami Forwarel <br /> star Landfill S�rrlitary 'Landfill Sanitary LL.;A11 F ,. Landfill <br /> .Sanitary <br /> • 9{Sti Bailey Read 12310 San Mateo Road 1601 Diann Landing Read 9689 S.Austin Road <br /> Pimburg,CA 94565 Bait MDon Bay,r4A 94DI Miipitas.CA 95035 Marltecs,CA 95336 <br /> Phone(92S)458-9600 Phone(650)726-18t9 Phone(408)945-2800 Phone(209)882-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax td08)262.28?1 Fax{208)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR 'r WASTE ACCEPTANCE NO. <br /> M1gIUNGADORESS ke <br /> Cm:STATE ZlP - r RECdl�lRED r�ERSONAL PROTECTIVEEQllIpI�1lEM1lT <br /> 'GLDvES D GOGGLES D RESPIRATOR HARD HAT <br /> PHONE <br /> A7 L]TY VEK U OTHER 4 <br /> CONT GTP SON -'` SPECIAL HANbUtiG PROCEDURES: <br /> SIGNATt1RE E�,�IjTmpRIZED AGENT 1 TITLE DATE <br /> AffitEf4t'i'OP'S �NI7FIG QN:I hare9Y CM�Y�via apace rnrnac rra.aAal is rd a heuerdoua <br /> qsi in da6ne4 tv 40 CFR 90R 161 or Ilea 22 gt etc.aplornla crda of regd&*Ma has been prowdY <br /> aao,asiraw armpack d end' in Rr tontbon For trortlpe[t3Nan a%eerWng to appuaala <br /> tLQttr:+r>a.ld�+stravamsnswu*er.prevro. ,,.se.iatd►,.zaesou.,aeete RECEIVIN[alR ILIT�' <br /> Tra <br /> aye e e snd D'apcad Rnlrct'bra,loa�Nr end�crroN lr�s thovraaa c erVW <br /> WO awd In - <br /> aoaorda>c. Csa rsRvva+r.erta G W RFR Pen 26!!a d la no Iarw a t%='doua wasteaa da"Z ty <br /> WASTE E: <br /> ISPOSAI. O SLUC GE <br /> Q CONSTRUCTION .�l SNOOD <br /> Q oEBRIS 7OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY "" <br /> r/ c �,T �J <br /> TRANSPORTER----r'" NOTES: VEiiICL CENSE NUMB TRUCK NUMBER <br /> ADDRESS <br /> N, TATE,ZI t a ' <br /> r l ✓�I E!VD DUMP $DTTOM DUfiAP TRANSFER <br /> P .- ; _ _ <br /> SIONl� RE OF AJ D A <br /> 'r-a04 nRIYER DATE R -��OyyF�Si FLAT-BED VAN DEQ <br /> CUBIC YARDS - _-- <br /> I hareby earl that that�/g above rammed material has been <br /> accepted and to the beet of my knowledge the faregaing DISPOSAL METHOD: (TO SECOMPLETEO UY LA aDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> MARKS G7 CONSTAUC-TION <br /> _ ..._. DEBRIS <br /> I=A <br /> ILITYTICKET NUMBER _ ,..w p NON-FRIABLE <br /> - ASBESTOS <br /> IGNA17URE CF;AUTi•ORIZED AGENT DATE <br /> ONO Q W000 <br /> o ASH <br /> ❑SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3.00 P.M.THE DAY Ii>7 EX _CTED ARRIVAL a ANY ilhlSClimULl•Q LOADS ARE 8LI6J&C <br /> TO REFUSAL UPON ARRIVAL, O(tiG0ING DAILY DELIVERIES [DUST BE SCHEDULED WITH THE LANDFILL THE DAY 13EFORE <br /> MANIFEST* 44 47 9Q'- <br />