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06/06/2011 14: 39 1-209-3 <br /> 6F1 JIM THORPE OIL PAGE 03/03 <br /> s MEW Lafrtl �1�1 %` <br /> 9D1 Bailay Road 12310 San Mateo Road 1801 Dixon Landing Road 9999 S Austin Road <br /> PfttshUrg,CA 94565 Half Moon Bay,CA 94019 MiIpAaS,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phona(650)728.1879 Pfwne(408)945.280D Phone(209)982-4298 <br /> I Fax(925)458-9891 Fax(850)726-0183 Fax(408)262.2871 Fax(209)982.100 <br /> a <br /> i <br /> NON•HAZARDOUS'WASTE MANIFEST <br /> GENERATOR, <br /> WASTE ACCEPTANCE NO. <br /> MAILING A p <br /> CITY STA E, REQUfRED-PERS::1,11IIIAL PROTECTIVE E UIP NT <br /> PHONE GGLOVES G3;GOdG4ir'S . Ci.RESPIR;ATCIRROH:AT <br /> CONT CT PEtiSt9,N <br /> HER <br /> SPECIAL HANDLING;PRgCEDURES: <br /> S1,NAT CIREtAOF 'UTt�IORIZED,,AGENT/TITLE DATE IV6/ ' <br /> eENERATOR'3C6A11FICAtIF1N IllproEy. y1he11ho ebw9 nemnd meWpel Ladylahaxardeur <br /> Nale ar obMgdby Ab CFR pert 261 wlidu 22 df the Calf In code d roWW(dna adi,binri prdpe,y <br /> ddocdean IneeIPnd Mdpacke6W en die lnproper mndifiaMmlydiwpglallpr,e�bprdl�lo applkedr <br /> regulmlplu;ANb,R lhr Wama la a 4pmfNI wider of a praYb Wy roetrwl.une:.naeur wes4 <br /> All tp lhb inndbApreeI llOalridlig",.I army all werca0 all lhr wgrte/l]P hreh lreale0 In .. <br /> eddpitlelEa wlm mr repulreman4of ro CFR Prtt26p eM la lro aper SWaminduawasre an deNnd by f LUUVING,FACILITY <br /> 4o aR.t'ari zel.. <br /> WASTE TYPE: <br /> DISPOSAL <br /> •CONSTRUCTION. ❑Webb <br /> ❑DEBRIS 0 OTHER <br /> ❑SPECIAL.WASTE <br /> GENERATING FACILITY <br /> I <br /> C/} <br /> 6Too <br /> w#4 S1" r-jant <br /> TRLSPORTArc 6: ,' QT St. <br /> ivPN1CL1 i90EFlSENUtIKEA TRUCK NUMBER <br /> AD RES <br /> CITY,STATE,ZIP <br /> - <br /> PHONE 0 DUMP et}TTOM.DUMP <br /> TiT�YN5FEf1, <br /> SIGNATUREOFAUTHORIZEDAGE.NTORD RIVER , DATE . KGLL,OFF(si .:1YAN 'ppU1S1'S� ; <br /> CUBIC YARDS <br /> hereby certify that the Above named Material Ill been ,J dS <br /> accepted and to the bast of my knowledge the foregoing <br /> Is true and accurate: D18POSAL,M OD: .,{FO 66NIIP.LETED BY L446MUl .` <br /> DISPOSE <br /> MARKS <br /> :4ft0t. IJCTION <br /> FACILIIYTICKETNUMBER - DEaRIS. <br /> O NON=FRIABLE <br /> SIGNATUREOFAUTH IZEDAGBNT DATE ASBE§TOS <br /> ,•�_..\ \� '�:, ❑WOOD <br /> ,/�.J� ]oti_ . ♦ r ':Cf ASH <br /> r`1" 'C•J / 0 SPEOIAL OTWER <br /> SCHEDULINGMUBTBEM EPRIO 3:OOPM.THEpAYPRIORmeXpiiCTED <br /> 10 ARRIVAL*ANY UNSCHEDULED LOAD9ARl;$ttBIECT <br /> REFUSAL UPON AR VAL,.o�iGOMtl DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 280927 <br />