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02/09/2005 WED 10 26 FAX 209 466 1067 FORWARD INC 2004/004 <br /> ❑ Keller Canyon ❑ Ox fountain ❑ Newby Island �Fonvard <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Barley Road 12310 San Mateo Road 1601 Dixon Landlnll F oad 9999 S Austin Road <br /> • Milpitas,CA 95035 Mantrtca,CA 85336 <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94tl19 <br /> Phone(925)458-9800 Phone(650)726-1619 Phone(408)945-21*0 Phon a(209)982-4298 <br /> Fax(925)458-9891 Fax(650)728-9183 Fax(408)262 2871 Fax(?09)982.1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ti wwrE ACCEPTANCE NO. <br /> MAILING AaDRESS -; <br /> CITYSTATE,ZIP REQUIRED PERSCNirL PROTECTIVE E5UIPMENT <br /> _ l f -91 GLOVES C3 00GGLE5 ❑RESi�iRATC7R ARD HAT <br /> PHONE �f• }- <br /> O TY•VEK U OTHER <br /> CONTACT PER,ON a SPECIAL HANDLING P110CEDURES <br /> SIGNATUREOFAUTHORIZE ITITLE DATE AfL-r <br /> GENERATOR S GEgTIFICATION I hereby certify LhaL the SbOVO named matpnar is Dol A hazardMZ <br /> rrdOt9 ee dgpngd by 40 CFA Nwi 26i or We 22 oI tm Cakromra Pods of ngulltAn! hag Been P-64 <br /> deecrrbetl Waswfiad and packapad,and a in pmp&achMon for IrensRonailon s cwclr O 30 aW)icabld <br /> IaUws AND It IBe welts la r trsae�sne roNdw of pmlPnsh�++ Td4Y"+°"a RECEIVING FAGILITI' <br /> y ,ca m g%j land rpt*sal�i CFR Pod�ena is gamer"we <br /> naazebrdous��a daetl"try -- <br /> „=«dar,d►wllh the�egw�o�nfs F <br /> 44)CFR Part 265 <br /> WASTE TYPE �(• <br /> ISPOSAL ❑SLUDGE <br /> ❑GONSTRUCT10N U WOOD — } <br /> ❑DEBRIS O OTHER <br /> - <br /> •SPECIAL WASTE <br /> . GENERATING FACILITY <br /> TRANSPOFITER NOTES vEHiCLE LI[NSE NUMBER TFiI ICK NUMBER <br /> ADDRESS <br /> CITY,STATE.ZIP <br /> END D P BOTTOM DUMP _ TRANSFER <br /> PHONE -^" ❑ _ <br /> SIGNATOR AU RIZEDA OR DRIVER DATE ROI_I.�FF S f1.AT�BBED VrA�N ORU S <br /> * <br /> to ! <br /> CUBIC YARDS <br /> I here certify that the above named material has been — <br /> accepted and to tate best at my knowledge the foregoing DISPOSAL.METHOD (I()uc COMPLETED BY I,/NDRLL) <br /> Is true and accurate DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS O CONSTRUCTION — <br /> DESRIS _ — <br /> FACILITY TICKET BER O NON FRIABLE <br /> A5BES708 — <br /> SIGNATUR F UTH ED A ENT / DATE ❑WOOD <br /> . f ❑ASH — <br /> *• a 8PECIA THER <br /> LOJOS ARE <br /> ECT <br /> SCHEDULINQ BE PRIOR M.THE DAY <br /> DELIVERIES MUST B�CARRIVAL H1TIi THE LANDFILL L DAV 9E ARE <br /> TO REFUSAL UPON ARRIVAL ONGOING MANIFEST 9 60692 <br /> aurtrit L COPY <br />