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'e:•Jy- <br /> 00 <br /> offirt8utte :' ❑Ox Mountain ❑Newby IslandI Forward <br /> 4 111 Lando SpnitaM Landfill Sanitary Landfill <br /> yf y<§ <br /> dad 78972 Coffin butte Road12310 San Mateo Road 1601 Dixon LandingRoad Landfill <br /> �r fi Cc Corvaliis,..OR 9733U Half Moon Bay, CA 94D1s MI9 S.Austin Road <br /> I�lta9.CA 95035 Manteca.CUA 9633$ <br /> k s 8-�8flD Phone(541)745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)$82 4298 <br /> Fax(541)745-3826 Fax(650)726.9183 Fax(408)262-2871 <br /> Fax(los)982 1UD9 <br /> NONHAZARDOUS WASTE MANIFEST <br /> k . <br /> WASTE ACUPTANCE NO. <br /> 9"n 14 <br /> "ST TE,ZIP REQUIRED PERSONAL PROTECTIVE EQ <br /> IP <br /> ' [GLOVES Cl GOGGLES 0 RESPIRATOR -C HARD HAT <br /> AC7•I�EA5ON 0 TY-VEIL 11SAFEf Y VEST <br /> SPECIAL HANDLING.PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AQENT/TITLE <br /> ddfERAI UR's CERTIFlCJITmN.Iof co <br /> Ce <br /> grey Owma above nwred <br /> as dv*W by ao CFR Pan 281 Bre Nfomta de nraNdar to rwl a *:- •�^"-"" <br /> ti i deealrfadandpedn�ed,and rs In pm;woondl m ror ba mparlaMon a <br /> "p'd°d0' rtgrpbea�"proparly <br /> AMri,M tha araaN Cil a k-tmant r■wfto of a pmvMu*re*fchd appNaahie <br /> rhe Gard Uspoaer Reemeffona,I aarury and in <br /> bee <br /> aerrarrt mer pre iraale hes r,treated <br /> Pani 261 the��°r CFR 2N and Is rw I hnwdooe+reem as dd kod by RECEIVING FACILITY <br /> WASTE TYPE: , <br /> --AOVIPOSAL O SLUDGE. <br /> O CONSTRUCTION q WOOD �- <br /> ❑DEBRIS ❑OTHER. <br /> ❑SPECIAL WASTE, <br /> GENERATING FACILITY <br /> l:Mlp ,Hloii�► TAwl• <br /> tRANSPORTER <br /> NOTES: .VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> Lod CA 95241 <br /> PHONE <br /> END DUMP BOTTOM DUMP TRANSFER <br /> S GN TURF OF AUTHORIZED AQENT OR DRIVIrR DATE <br /> ROLL-OFFS FLAB BED VAN DRUMS <br /> ° ° ° <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> IS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED By LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> FACILITY TIC ET NUMBER 0 CONSTRUCTION <br /> DEBRIS <br /> U NO RIABLE <br /> SIGNATOR 0 AUTH RIZEa� GENT OTE AS TOS <br /> �" f, :; ,_ WOO <br />