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02/09/2005 WED 10:26 FAX 209 46067 FORWARD INC Q004/004 <br /> ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island �'" :onvard <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landinp F.oad 9999 S.Austin Road <br /> Pittsbvrg,CA 94565 Hall Moon Bay,CA 94019 Milpitas,CA 95035 Manti fca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726.1819 Phone(408)945-2800 Phon 1(209)982-4296 <br /> Fax(925)458.9891 Fax(650)726.9183 Fax(408)262-2871 Fax('09)962-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GE ATOR 1 WAS1rE ACCEPTANCE Na. <br /> MAILING ADDRESS <br /> . � l <br /> CITY,STATE,_ZIP REQUIRED PERSCN.kL PROTECTIVE EDUIPMENT <br /> GLOVES ❑COGGLES O RESPIRATOR ARD HAT <br /> PHDNE ,V);�_ <br /> CONTACT PER ON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZE /TITLE. DATE /y <br /> GENERATOR'S CERMCATION!I hereby o9rtlly thal me eboys named rttatwint fe not a hannIOus <br /> wasto as debrad by 40 CFA t'en 251 or lids 22 of tiro Caeromla oode of m9ukOms,hoe begirt ptpperty <br /> deecrlbed.d=%ired and packa000.and is in proper 6m%mon ktr IrBr wwakh a•G)rainp to appli4mbio <br /> f6pvIaGor s;AND,K the waste N a lamlealdua CIS nnrlouWy n,.h1ated trosardow t..aie - <br /> sVdr"XY]rotnELandOleposalFWrMi4na.loetlltyand wa,ranknl[he++seleha9beonMated'u+ AEGEIVINGFACIUTI' <br /> ageordanea wnh atv r97tirwnw%6 6f 40 CFR Pan M wx0 is rto longer a hazardoOswaSm as dented by -- <br /> 40 CFR Pan 265. t <br /> WASTE TYPE: A(� <br /> Zen Z�T— <br /> ,)ErOISPOSAL O SLUDGE -- <br /> ❑CONSTRUCTION U WOOD — <br /> Q DEBRIS O OTHER ? <br /> 1.7 SPECIAL WASTE <br /> GENER NG FACILITY — – <br /> 1..�� <br /> TRANSPO TER NOTES: VEHICLE LIC•!SE NUMBER Ts 1JCK NUMBER <br /> ADDRESS r / <br /> CITY,STATE,ZIP <br /> PHONE END DU P —imfrOM DUMP --TRANSFER <br /> SIGNATUR AU RdED A O!�DRIVER DATE ROLL-OFF(S) AT BI=D VAN_ DRUMS <br /> D _.FL_U Q1 G� <br /> CUBIC YARDS _ <br /> I here4 certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing DISPOSAL INETHOD: (10 6E COMPLETED BY I ANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> Q SOIL _ <br /> REMARKS ❑CONSTRUCTION <br /> FACILITY T1CKE'-f BER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUR F LITH ED A ENT DATE Q WOOD <br /> Q ASH <br /> 0 SPECIA THER <br /> SCHEDULING BE PR10R 00 P.M,THE DAY PRIQRTO EXPECTED ARRIVAL•AWV UNSCHEDULED LW.Ds ARE SUBJECT i <br /> TQ REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST 9E SCHEDULED M9TH THE LANMANIFDFILL ST L T iRE- <br /> F_0 6 9 2 <br /> a> nral L(X)PY <br />