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FORD NON-HAZARDOUS WASTE MANIFEST <br /> I N C OR"PRrtA E D WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. ,F 64 -- 5bo <br /> GENERATOR _ REQUIRED PERSONAL.PROTECTIVE EQUIPMENT <br /> L �$pti1 &A4) -� GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS t _ _- - _ ❑TY-VEK ❑OTHER <br /> CI Y,STATE, ZIP SPECIAL HANDLING PROCEDURES <br /> - - - <br /> - P_ CA-Pa Cj�3 �L <br /> - N <br /> CONTACT PERSON _ <br /> Pz55 l�ELSa c•� _ _- _�— <br /> ,SIGNATURE OF AUTHORIZED AGENT /TITLE DATE - <br /> r <br /> WASTE TYPE _ T RECEIVING FACILITY —_ <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • 2--DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ,90141 CA (209) 982-1009 FAX <br /> NAME NOTES { TRUCK NUMBER <br /> -- --�,��-� <br /> ADDRESS <br /> • CITY,STATE ZIP _ r- <br /> • _ 732-61 i-- WrD 397 <br /> PHONE — - END�t1N�Ia BtTOM DUMP TRANSFER <br /> - " _ °_ TM - --- -- El <br /> - <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE _ROIL..-OFF(S) FLAT-BED VAN DRUMS <br /> * - - - - ❑ ❑- - ❑ - ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept therwast Bather or other <br /> conditions impair the safe and effective disposar"ol the to or if the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfdf Forward shall use <br /> reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE -BIO AERATE STOCKPILE_ --OTHER <br /> waste for any reason If forward s refusal to accept the waste is based on <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 [:1SLUDGE. <br /> ` REMARKS --- -- <br /> —- - --- -- - -- ❑ NON-FRIABLE <br /> _ _ _ _ ASBESTOS <br /> FACILITY TICKET NUMBER - _ <br /> -- --- - _--_ _.- -- - --- -- ❑ WOOD ` <br /> SIGNATURE OFAUTHORIZED AGENT ^--- - DAT - - <br /> -- - - -- - ------ - --- -- -- -- - ❑ ASH <br /> OTHER <br /> IIIIIIIIIIIIIllm <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 /> s TO SCHEDULE CALL(209)982-4298 MANIFEST# 108703 <br /> GENERATOR COPY <br />