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01/15/1001 MON 10 .14 FkX 209 488 1007 FURW'ARD INC Z000/011 <br /> C] Keller Canyon 0 Ox Mountain L7 Newby island -eFotward <br /> San6tary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> ' 901 Bailey Road 12310 San Mateo Road 1801 Dixon Landing(load 99%S Austin Road <br /> • Piustlurg,CA 91565 Half Moon Bay,CA 94019 Milpitas CA 95035 Manteca.CA 95336 <br /> Phone(925)459-9800 Phone(850)726-4819 Phone(408)945-280 Phone(2D9)982-4296 <br /> Fax(925)4.58-9891 Fax(650)726-0183 Fax(408)262-2871 Fan(209)982-1006 <br /> ' NOWWARDOUS WASTE MANIFEST <br /> EN TOA WASTE ACCEPTANCE NO. <br /> Co\K,A At.r Se,5 <br /> MAILING ADDRESS 90 <br /> B0�e =El <br /> CITY.STATE,ZIP TIE-g—L—IR—ED PE AL PROTECTIVE EQUIPMENT i <br /> d VN Oiarrj <A -krL-710 D SLOVEES U GOGGLES ;)RESPIRATOR O HARD HAT <br /> PHONE <br /> q 5T _ o Tyr-VEE a OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> gIGNATUREOFAUTHORIZEDAQENT/TITLE PATE <br /> gA4tvro#� [.ti�LV Ct <br />' mc <br /> acNwAmwS 0514T11CATIOM 1 hurry a&Vy Ws stir adar mord+aabr4U Ir no a hmL dmm <br /> wOl�rs NMMd by CPR rrrr bit ar 11N d C.rdosnla nvdr of wpufa9ay. srr++sa<0 01 <br /> 6rra6b.dsrtisre ab Mp a In Voi+u eenypan Iqr arotrpo�Ssllun <br /> ,Am NNW warm to a umbaw 1wm of r p�M10�Yt NrOtrlld wr�'1r <br /> wwLanaolapraesRnaoktlrss+.sa.nNvand+w'rN"urwrorneelsernpvauwin <br /> RECEIVING FACILITY <br />' A000drne.wtli ar ogrren�rnn d i0 C!'R sus 2dlf�d n na r hstrsaan rrspw p drArwd bi <br /> 10 s�PSN�1 <br /> WASTE TYPE <br /> WDISPOSAL 1]SLUDGE <br /> O CONSTRUCTION R WOOD <br />' ❑ O OTFI <br /> HL <br /> d SPECIA sPECiAe_WASTE <br /> CiENEAATING FACILITY <br /> 'a-+-SS IAJ-A?'brd <br /> MSPORTMBEFI NOTE VEHICLE UCEPM NUTRUCK NUMBER <br /> r Ono <br /> t� <br /> E,ZIP <br /> E F-No DUMP BOTTOM DUMP TRANSFF <br />' FC RE 1 DRI R ROLL—W(5ROLL-W(sl FLATBED VAN DRUMS <br /> ® ❑ ❑ a <br /> o -Z q-6 <br /> William <br /> cu <br /> I hereby cortlty that the above named material has been <br /> acWted and to the beat of mil knowledge the foregoing DISPOSAL MEWD (1n gE COMPLUE:D eY LANDFILL) <br /> Is Ww►and accurate. <br /> DISPOSE OTHER <br /> rMARKS O SOIL <br /> D CONSTRUCTION <br /> ITY CKECJ NON-T NUMBER NONi9 <br /> FlUA6LE <br /> ASBESTnS <br /> SIGNATUREA flAGIEN'f ATI' ❑WOOD <br /> ASH <br /> 31 OTHER <br /> 80"L*40 muw BE MADE PRIORTO 3,00 PA.ThE GAY PFgORTD EED(P0C ARRIVAL r ANY UNSCHEEDULEv LOADS ARE SU 11NECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DGLIVE@RIErS MUST BE SCHEDULED WITH THE LANDFLL THE DAY BEFORE <br /> .. ,, mANIFF.ST 27325 <br />