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{ <br /> NON-HAZARDOUS WASTE MANIFEST <br /> FQRWARD WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC JOB ACCEPT NCE NO _ - - <br /> . - �Q <br /> GENERATOR _ _ _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Nelson Ready-M�x_ _ - - _ _ _ [:]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS _ ❑7Y-VEKP. ]OTHER <br /> CITY,STATE,ZIP <br /> - _ SPECIAL HANDLING PROCEDURES <br /> -- - <br /> Ripon,,_CA 95366 <br /> PHONE <br /> CONTACT PERSON <br /> RtasS Nelson _ <br /> SIGNATURE OF AUTHORIZED AGENT /TITLE _ DATE_ <br /> WASTE TYPE___ _ _--_ -- _ - _ REC,EIVI01?F <br /> r C1TY`6- <br /> �l -7� ---- --- - - <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORT. RD INC LANDFILL <br /> • ® DISPOSAL SOIL ❑ WOOD ` 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY_ (209) 982-4298 PHONE <br /> Nielson Ready mix Concrete Plant, <br /> 22700 S. Hwy 99 (209) 982-1009 FAX <br /> Fipon, CA 95366 <br /> NAMENOTES/ TRUCK NUMBER- <br />�J Rich hamu1_tonTruck�g � �- - _ - -- - _ <br /> ADDf ESS <br /> 1217-S.7th_ Street _ -- _- -- - - - 4 c <br /> . CITY,STATE,ZIP _ mm _ - _ ` V 14 5- a <br /> • Modesto, CA 9.5351 <br /> PHONE END DUMP _ BOTTOM DUMP TRANSFER <br /> 209=578--4100- - --_- - _ ® ❑_ _ - - 11 - <br /> SIGNATURE OF AUTH_ORIZ D A_ OR DRIVER DATE ROLL-OFFS) - FLAT-BED VAN DRUMS <br /> 8-11--99 El <br /> FORWARD INC, LANDFILL CUBIC YARDS _ <br /> Forward shad]have no obligation to accept the waste if weather or other <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall use <br /> reasonable efforts to promptly notify Disposer of its inability to accept the __ _ DISPOSE 1310 AERATE STOCKPILE OTHER <br /> waste for any reason If Forward's refusal to accept the waste Is based on SOIL <br /> weather or other site conditions Forward shall notify the Disposer when site <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste _ ❑ SLUDGE <br /> • REMARKS ❑ <br /> NON-FRIABLE <br /> FACILITY TICKET NUMBER_ ASBESTOS <br /> - —- - - - - - ❑ WOOD <br /> SIGNATURE10F AUTHORIZED AGENT _ DATE _ <br /> ASH <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL(209)982-4298 GENERATOR COPY 49697 <br /> MANIFEST# <br />