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Ila.ellck t"anyon Gof in Sldo FI Ox Mounta'm Newby Island L:J Fummi-d
<br /> Sonliary Lmidfill Landfill Sanitary Landfill Sn Iry Lan'dMV,
<br /> DO I F'i1rjV ,C
<br /> 1�)
<br /> 2'C' 7 r1l rj' K L,'wdl!z�l R(—v i Q9't' Aursiil I RuudRuud,, _D 71 1231 Cl()Son,tvlaV�o R(,,ad
<br /> I'01-ituig, CA CoivaN,�_ CH .1T'1'30 Half fkjori Bay, CA 94019
<br /> Irvlanloci,-(-A
<br /> 159-91>)C) phnl it-, f5--i 1) 745?'118 Phone (65(j) 726-1819 F[Ignr (d0-9)945 120='!)
<br /> Fax 1. ((350) 7.6-9183
<br /> Fax J 1 7,45-.38'(3 Fax Fax (209) 98- 10,09
<br /> NON-HAZARDOUS WASTE MANIFEST
<br /> NmATon
<br /> MILFNG
<br /> I'_Y, STATE, ZIP REQUIRED PE RSONAL PRO]ECTIVE EQUIPMENT
<br /> .]GLOVES FJ GOGGLES 'i nFSPIRATCR JiAnD HAT
<br /> PHONE
<br /> A TY-VEK JJ-",%AFFT)'V[S`
<br /> CONTACT PERSON
<br /> SPECIAL HANDLING PROCEDURES
<br /> SIGNATURE OF AUTFIOR IZED AGENT/TITLE DATE
<br /> G5NERATOP"S CERTIr 77T_DN1 named material is ITI)f a hazardous
<br /> waSIUas d9fli}qd by iC CFR Pari 2x:1 w 1'1143 22 of the CaFoinii rodO Of r,qijlalians,has b9pri ptcp9ily
<br /> AuscrbcO,clacvtq-j and p.ickapcl,and Is in phcpor cofvlllrnn for 11P-tsporialicii a-ccdinq Jo applicable
<br /> r-pdationsJI.VD,11 the%,>qrj�
<br /> . , J,,I,nmment rtsldir-i of a previcurly re2tr1cre6 ha"rilaus wl',to
<br /> 51111ert ton I ond Ul�p2a�Rgilr0mrS.I cl)ltOy and warrant Ifial the w4.qJ6 has . trealol i ------
<br /> ,�Kxorihip-,n wQi tho requr,oi-,r1i o1 40 rFr-i Fart 3 and;s no lwiq,,h,3,,.RFd111 11111 11 in
<br /> t', RECEIVING FAGILI IV
<br /> ,10 CFR F'3,1 2gi.
<br /> WASTEPE:
<br /> -':J_bISP0SAL USL.I.IDGE
<br /> IJ CONSTRUCTION Q WOOD
<br /> _1 DEBRIS IJ 01 H ER
<br /> USPECIAL WASTE
<br /> zp
<br /> TRANSPORTER NOTES: VEHICLE I CENSE
<br /> UNUMBER TRUCK
<br /> NUMBER
<br /> A—bDRESS
<br /> CITY,STATE, ZIP,
<br /> END DUMP BOTTOM DUNIP TRANSFER
<br /> J Ij
<br /> SIGNATUJhEbF_A_UT-HO R IZ ED AGENT�OFA DRIVER -DATE ROLL' OFFS)
<br /> FLAT-BED VAN DRUMS—
<br /> L)
<br /> ...... ......
<br /> -M, W-MIUM OWN_VA CUBIC YA 'DS
<br /> I fiel'eby GPIlify that the above narned material has been
<br /> ,-CcePted and to the best of my knowledge the foregoing
<br /> is true and accurate. DISPOSAL MEI-HOD: JO BE COMPLETED BY LANDFILL)
<br /> DISPOSE OTHER
<br /> FfEMr'j SOIL
<br /> ARK
<br /> U CONSTRUCTION
<br /> FACILITY TIGKET NUMBER 4� DEEIRfS
<br /> 'J NON-FRIABLE
<br /> ASBESTOS
<br /> 9_IG_fq ATU R E OF Adi�Ijb P 12 ED—AGENT DAT E
<br /> U WOOD
<br /> Q ASH
<br /> U SPECIAI-OTHER
<br /> a'7 2'- A10 �3
<br /> ,
<br /> 17
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