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04/20/2004 15: 46 209636 35 GREEN VALLEY TRANSPO PAGE 03 <br /> ❑ Kotler Canyon ❑ ountaln I_j NewDy Irl I t`vrw�ill <br /> Sanitary Landfill Sa ltary Landfill Sanitary L flli LanSrAus11n Road <br /> 901.Bailey Road - 12310 San Mateo Road 1601 Dixon Lending Road Manteca,CA 95338 <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milplfe3.CA 95035 Phone a,C 982 6 <br /> Phone(925)458.9800 Phone (650)726.1819 PlI(408)945.28M Phone(2 9)02-49 <br /> 296 <br /> Fax(925)458.91391 Fax(650)726.9183 Fax{408) 262-2871 <br /> Fax NON-HAZARDOUS WASTE Ai AwES.T <br /> GENERATOR e— ' f [ r =' ' "`� ?°FL <br /> WASTE ACCEPTANCE NO. <br /> CITY.STATE,ZIP 'r REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> o, <br /> U GLOVES D GOGGLES D RESPIRATOR D HARD HAT <br /> PHONE <br /> ❑TYI O OTHER <br /> CONTACT PERSON '' %' <br /> SPECIAL HANDLING PROCEDURES: <br /> (I <br /> SIGNATUR OF AUTHORIZED AGENT I—TITLE DATE <br /> T� C)t <br /> rENMATOR'S CEWIFICAT Thereby CPMly that the above named matanal is not a hlZerdow <br /> .sale as defined by 4ff GFR ped 281 Or Mlle 2201Ina Canomia code of rfqulepuna,hae peen Properly <br /> described.cloasiaatl>•nd wkagad.andls�M P"m oondlllon for tmMoortation a-oerding to applimble <br /> raAuenone;AND,alha IN!"latalRaN,ard MIO—of a Prbo"'y M"n"ad hamu'l,us Mala RECEIVING FACILITY <br /> i <br /> aubl o ldLand Dlsposel Rmtrlstlans,l aendy and.","Thal the Mote has peen MAW In <br /> etShcd 01 Llh the regWtamnMs el 40 CFR pad 286 and it no longer a h=Mwa,emM m donned by <br /> AD CFR Pan 281, <br /> WASTE PE: ` ' <br /> ISPOSAL ❑SLUDGE <br /> NSTRUCTION O WOOR <br /> O DEBRIS ' 'T <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORT-ER I 7i.%1 NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS G <br /> CITY,STATE,ZIP'! - 4 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> J Q LI <br /> ❑ <br /> VAN <br /> SIGNATURE FAUTHQRIZEDAGEN 1 OR DRIVER DATE ROLLOFF S FLAT-BED DRUMS <br /> ' <br /> r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> a SOIL <br /> MARKS _ D CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMSEIT ❑NON-f RIABLE <br /> ASBESTOS <br /> SIGNATURE OFALITHOR DAGENT DATE OWOOD <br /> ❑ASH <br /> ❑SPEOIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT3:00 P•M.THE DAY PRIOR To EXPECTED ARRIVAL•ANY UNSCHEDUL$D LOADS ARE SUBJEC' <br /> O <br /> . 6NGOING DAILY DEL <br /> TO REFUSAL UPON ARRIVAL MUST BE SCHEDULED WITH THE MANIFEST Y 66387 ORE <br /> TRANSPORTER COPY <br />