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r rNON-HAZARDOUS WASTE MANIFEST <br /> ViF7W WARD WASTE TREATMENT AND DISPOSAL FACILITY <br /> fY JOB ACCEPTANCE NO. ` -_,500 <br /> GENERATOR _ _ — _ _ _ _ _ _ _ _ RQUIOED <br /> PERSONAL PROTECTIVE_EQUIP_ME_NT <br /> Nelson Ready M1x _r __ ___ _ _ � _ ___ GLES E GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ❑TY VEK []OTHER <br /> P.O. BOX 29 �_ _ — _ _ _ - SPECIAL HANDLING PROCEDURES <br /> CITY,STATE,ZIP <br /> Ripon,_CA 95366 — <br /> PHONE <br /> 20_9-46_6--2_889_ _ — _-- --- -,--- - - ---— -- - -- r <br /> _CONTACT_PERSON <br /> Russ URNelson_ _ _AG <br /> ___ _ <br /> SIGNATE OF AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • Q DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ - _ _ _ —_ _ _ _ (209) 982-4298 PHONE <br /> Velson Ready Mix Concrete Plant <br /> 2700 S. Hwy 99 (209) 982- 1009 FAX <br /> fin, CA 95366 <br /> NAME \ _- _ -- _ NOTES TRUCKNUMBER <br /> ADDRESS Rich_tia►n <br /> Aii ►r,-„_eking <br /> 1217 S. 7th Street <br /> . CITY,STATE,ZIP (3c <br /> • I odesto,_ CA 95351_ _ _ _ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> • 209--578--4100 - - - _ _ _ _ � _ _ ❑ __ _ _ ❑ <br /> SIGNATURE-OF-AUTHORIZED-AGENT OR DRIVER DATE DOLL-OFFS) FLAT-BED_ _VAN DRUMS <br /> - - 1:1 ❑ o ❑ <br /> 8-11-99 <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other 4 <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 _ _ _ DI BIO AERATE Si KPJLh OTHER- <br /> waste for any reason If Forwards refusal to accept the waste is based on OIL J �— <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 <br /> REMARKS_- ❑ SLUDGE <br /> • - M _.. - - - <br /> - - - NON-FRIABLE <br /> _ _— NU_ ❑ ASBESTOS <br /> FACILITY TICKET MBER <br /> -- - - - ---— �-___ _----- -- --- - - — E] WOOD <br /> SIGNATURE OF AUTHORI AGENT DATE <br /> -- - --.-- -- - - -_7- <br /> E] ASH <br /> W ' ❑ OTHER <br /> vEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> ECT 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 MANIFEST# 496918 <br />