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' 04/1111003 110N 14 11 FAX 209 466 10137 FORWARD INC (&02/002 <br /> ❑ Keller Canyon ❑ OX Mountain p Newby Island JWForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 ISMay Road 12310 San Mateo Road 16D1 Dixon Landrng Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Say,CA 94019 Milpitas.CA 95095 Manteca,CA 95336 <br /> Phone(925)458.98W Phone(650)726-1819 Phone(409)945-21500 Phone(208)982.4298 <br /> Fag(925)458-9891 Fax(660)726.9183 fax(408)262-2871 Fax(209) 982-1009 <br /> ' NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO <br /> t T ,+� r��Ce.S <br /> MAILING ADDRESS J <br /> ' tV <br /> CITY STATE,ZIP E R P OTECTIVE QUIPMENT <br /> t Q ❑GLOVES Q GOGiGLES O RESPIRATOR Q HARD HAT <br /> PHONE <br /> 7.- .5vack O TY-YEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Q C eW <br /> V(3NATU E OF ALlTHORfYED AGENT 1 TITLE PATE <br /> fi <br /> Jam.. vr ate. <br /> 4EN�N1TOR6""PICAUK 111 . Or*MW"01ow'"W nutMtal b'M11 NUMM' <br /> vow"as�fJ br 40 CPR Part 261 arm 22 of 1ti CA19oR+k o00�d r*;1AII1W .11N/DMn PAY <br /> 41f1a1b00 t{6ifip 1 am ppl7:d iIRI N!7 C1C/1�to11 Ibf lf4116ptlflibgf� b 1ppACib4 <br /> f�pJfaG01M ANq @(♦si Ynit�b YYtt11YQ (0 fa p"OY*1MtIkw MpN01v 1of4 <br /> wt�ca w d r lend Ghpa�1 q/tV100pt1{1 w1t rurt rwraftl 4nI1110 w w bmn M RECEIVING FACILITY <br /> iiomdanoa a,M1i tM r gnrtrtenLL 0140 CFlt Put 2114 94111 w 1qnW a I MoWdwo trop o&PMW oy <br /> 49 GFR PM 261 <br /> WASTE TYP <br /> O DISPOSAL Q SLUDGE <br /> a CONSTRUCTION D WWI) <br /> P DEBRIS '8(pTHER <br />' U SPECIAL WASTE <br /> GENERATING FACILITY <br /> ta\4 N�•l� �� 5��, S�o�1fG�. Gb <br /> TRANSPORTER NOTES IVEHIGLEUCENSENUNWRI TRUCK NUMBER <br /> ADDRESS <br /> CITY�STATE,ZIP <br /> END DUME DUMP THMSFER <br /> SlIGNATURIC—OF AUTHORIZED AGENT DATE LL-0 S FLAT-BED VAN DRUMS <br /> ❑ 0 ❑ a <br /> CUBIC RDS <br /> I herald certify that the above named material has been <br />' accepted and to the bast of my knowledge the foregoing DISPOSAL METWX CM BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> IL <br /> FtEMARKS p OON3iRUCTiQ1i <br /> DEBRIS <br /> 11 7 NUMB D NON•FRINSLE <br />' ASBESTOS <br /> SIGNATUR A EMVTTWTE <br /> O WOW <br /> / O ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST Be MADE PRIOR TO 3.00 P.M.THE DAY PRIORTO DCPEC I1:D ARRIVAL•ANY UNSCHEDULED LOADS AR!$UIWECT <br /> TD REFUSAL UPON ARRIVAL ONG01No DAILY DELIVERIES MUST BE SCHEDULED WITH TIME LANDFILL THE DAY BEFORE. <br /> MANIFEST# 38950 <br /> Ai41".r.. ♦. awL/ <br />