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06/06/2.011 14: 39 1-209-01851 JIM THORPE OIL * . PAGE 02/03 <br />N.C <br />.. .111,11.11. '.." "Wilil <br />k-� t qD <br />m <br />K <br />6r, <br />Landfill <br />99995. Austin Road <br />cuff. M.. Marl%rcal CA. 95986 <br />p NMI. <br />t6 t:fl Tn� Phohe (909) 982-4298 <br />AV., DANCE NO. <br />ll <br />E EQUIPMENT <br />R SXfARD: HAT <br />Is I-V T <br />V� <br />TE TYPE'. <br />;ff DIVOSAL DSLUDGE <br />MCONSTRUCTION U w6bb <br />(3 1X9RIS 0 OTHER <br />Q SPEGIAL WASTE <br />....... <br />CNERATiNG FACILITY' <br />6. 0II :6, To Or- 13 N C14 <br />ow <br />PORT <br />NOTES`- <br />� ! j art, T#c. <br />lyTw <br />A RES <br />31V <br />j:., V. <br />cITY, STATE ZIP ­ <br />PWgNE 4-vfc� <br />ENDWIVIP SaT70MIDUMP TFIAqSF-_ER: <br />I v WK14 <br />a, <br />SIGNATURE OF AUTHOR IZEDW(-W"K�iFIEI; <br />L-OrMS). FLAT-BED VAN DRUMS,. <br />0 <br />I hereby oartity that a - 66ve Ohilhad inaiddat hiaabe6h. <br />aacepted and to the beat of my'knovAledge thb foregoing <br />Istrus and accurate: <br />QVJB X <br />M.YFADS. <br />SPOSAL-METROD: (To BE COMOLE' rED BY LANDFILL) <br />DISPOSE OTHER <br />.0 SOIL <br />NIZA-RKS <br />• <br />D CONSTPUCTION <br />FACILITY TICKET NUMBNDEBRIS <br />A . 88E.Vros <br />SIGNATURE OF AUTHOHIZEOAGENT I DATE <br />U. WOOD <br />SPECIALOTHER <br />A <br />SCHEDULING MUST BE MA09 PRIOR -TO VOOF ORT00KICTEDARRIVALtANY <br />UNSCHEDULED LOAUSARIESUBJECT <br />