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WAND NON-HAZARDOUS WASTE MANIFEST <br /> IF. DRWASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. = q 0 <br /> GENERATOR _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT _ <br /> Nelson_Readj,Mix = _ _�__ - ❑GLOVES ❑GOGGLES 0 RESPIRATOR ❑HARD HAT <br /> MAILING ADDRES _ _i _ _ _-_ ❑TY VEK ❑OTHER <br /> P.O. Boy, 29 - - - -- - - - - - - - - _- - SPECIAL HANDLING PROCEDURES <br /> • CITY STATE,zl P _-�____ _ _ _ - _ _ _ _ __ __ __ <br /> ' Ripon,--CA- 95366_____ <br /> PHONE <br /> 209-466--2884- <br /> CONTACT-PERSON <br /> 09-466.2884-CONTACTPERSON _-- <br /> Russ-Nelson <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> • ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ED DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> • ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ _ _ _ - __ _ (209) 982-4298 PHONE <br /> Nelson Reddy Mix Concrete Pians <br /> 22700 S. Hwy 99 1 rr 2 p g) 982- 1009 FAX <br /> Ripon, CA 95366 <br /> NAME (� NOTES TRUCK NUMBER <br /> Rich Hamilton <br /> '�'�ru�}u�g�� �c3�Z_I�ac �_ - - -- --- --� -- - - <br /> ADDRESS --- - _- _ _ y <br /> C G- ---- <br /> 1117-S. _7th .Street __-- <br /> • CITY,STATE,ZIP <br /> Modesto, CA 9535 - <br /> PHONE _ END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 _ _ -- - _ @- - 11 - - - - El <br /> SIGNATURE OF AUTHORIZED DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUM$ <br /> - , -AGENT-OR - ❑ ❑ ❑ ❑ <br /> * B-11-99 <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 DISPOSAL METHOD (TO BErO,MPLETED 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 BtO ` AERATE STOCKPILE OTHER- <br /> waste for any reason If Forwards refusal to accept the waste is based on <br /> weather or other site conditions, Forward shall notify the Disposer when site SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste [-] SLUDGE <br /> ' REMARS K --.�-- - -- -- --- -- — ----_ _- __-- - <br /> • R - — - -- -- -- - - - - - - - ❑ NON-FRIABLE <br /> NU <br /> FACILITY TICKET MBER ASBESTOS <br /> w �Y. ----- <br /> E] WOOD <br /> SIGNATURE OF AUTHORIZED AGENT <br /> _ _ ❑ ASH <br /> 7�C f l ❑ 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 <br /> MANIFEST# 49699" <br /> 1 GENERATOR COPY <br />