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1 FORWARD -- NON-HAZARDOUS WASTE MANIFEST <br /> t ►��� 1 WASTE YREATMENT AND DISPOSAL FACILITY <br /> �,►b INCORPORATED - <br /> - JOB ACCEPTANCE N0. <br /> REQUIRED PERSQKAL PROTECTIVE EQUIPMENT <br /> GLOVES ❑GOGGLES ❑RESPIRATOR , ❑HARD HAT <br /> Nelson Ready...Mix_--� -- ----. --- —_.��-, _ <br /> _MAILING ANN& ❑TY-VEK ❑OTHER <br /> .0. j30:K_29_ : -_ - - -'--' -= - -- -�- SPECIAL HANDLING PROCEDURES <br /> CITY, TATE,ZIP <br /> • Rippoon, SA 95366-_ _______--_ _ -= - — , <br /> NE <br /> _209-466-2884 <br /> CONTACT PERSON- <br /> -Russ-Nelson- <br /> SIGNATURE <br /> ERSON <br /> RusSNe sonT _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE y DATE <br /> WASTE TYPE _ _ _ _ _ _ __ _ RECEIVING FACILITY <br /> ❑ SLUDGE - <br /> ❑ TREATMENT SOIL ❑,NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • E] DISPOSAL SOIL 01WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL 419ASH _ <br /> ❑ OTHER . } � MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _` _- _ _ __ _ (209) 982-4298 PHONE <br /> Nelson_Read_j Mix Concrete Plakr 209) 982-1009 FAX <br /> 22700 S. Hwy 99 ` _ <br /> 141pon, CA 95366 <br /> NAME _ a___ _ ___ _ _ NOTES `TRUCK NUMBER - <br /> Rich 1%milton Truc49L j� <br /> ADDRESS �;� =_ <br /> 1217 S. 7th Strt <br /> ee <br /> . <br /> CITY,STATE,ZIP <br /> Modesto, CA 95351 _ _ _ w _ _ __ _ _ _ <br /> • PHONE _ _ — _ _ - _- _ _EN DUMP_ BOTTOM DUMP _ TRANSFER <br /> R <br /> 209-578-410_0 --- _ - _- - _ _ `-� - ❑� ❑ - - <br /> SIGNATURE OF AUTHORIZED ENT OR D R DATE ROLL-OFFS) _ _FLAT-BED 2 VAN _ :R DRUMS _ <br /> FORWARD INC:LANDFILL `, CUBIC YARDS_ _ _ <br /> Forward shall 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 DISPO AL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall use DISPOSE BIO AERATE STOCKf'[i E OTHER <br /> j2 <br /> MOIL <br /> efforts to promptly notify Disposer of its inability to accept the _ _ _ _ R _ __ - <br /> waste for any reason If Forwards refusal to accept the waste is based on OIL - <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 - - -- - - --- - _ - - - - - - NON-FRIABLE <br /> _ _—_ -- _ - _— _ _ _ _ r _ -- ❑ ASBESTOS <br /> FACILITY TltGi ET NUMBER <br /> _ _ ElWOOD <br /> . SIGNA URE O HORIP�ZE AGENT DATE <br /> - �__ - ❑ ASH • <br /> * / t / ❑ OTHER <br /> f <br /> SCHEDULING MbST-BE MADE PRIOR TOO 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 MANIFEST* 76553 <br /> GENERATOR COPY <br />