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NON-HAZARDOUS WASTE MANIFEST <br /> WARD WASTE TREATMENT AND DISPOSAL. FACILITY <br /> Mr. - , A <br /> JOB ACCEPTANCE�NO.e $�i — �4 <br /> GENERATOR _ _ __ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> NelsOri M1 X _ - _ ❑GLOVES 0-6 <br /> OGGLES E]RESPIRATO <br /> - R []HARD HAT <br /> MAILING ADDRE ❑TY-VEK ❑OTHER <br /> P.O. &ox_29-_ _ __ _ _ _ ___ - - - SPECIAL HANDLING PROCEDURES <br /> CITY,STATE,ZIP <br /> • Ripon, CA_95366 _-- <br /> PHONE <br /> (209)--4667-2884 _-- <br /> CONTACT PERSON — <br /> Russ Nelson _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE v DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • [� DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACIUTY __ ___ _ __ _ _ __ - _ _ _ (209) 982-4298 PHONE <br /> Nelson Rudy Mix concrete Plant <br /> 22700 S. Hwy 99 2 0 9) 982- 1009 FAX <br /> Ripon, CA 95366 <br /> NAME- NOTES --- - -- __TRUCK N MBER <br /> Rich Hamilton-T V7 <br /> r�r <br /> ADDRESS ----- - - — <br /> i,l <br /> + _ T <br /> 1217 S.-7th St. <br /> • CITY,STATI=a ZIP _ _ _ _ _ _ _ _ (; r g <br /> Modesto, CA 95351- _ - -- -- - �— 7� [ <br />-— PHONE !� � r END DUMP BOTTOM DUMP _ TRANSFER _ <br /> 209-578-4100 © - ❑ _ ❑ <br /> SIGNATURE OFjAjffHORIZED AGENT OR DRIVER DATE - -ROLL-OFF(S) FLAT-BED -VAN - DRUMS <br /> 8 X11-99 ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL cuBlc 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 wasteVISPOS METHOD (TO BE COMPLET4D BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall usereasonable effods topromptly notify Disposer of its inability to accept theDfSP05E BIOAERATE KPII£ pTHER <br /> waste for any reason If Forward's refusal to accept the waste is based on T <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_µ , <br /> • - - ' - - - NON-FRIABLE <br /> _ _ __-__ - - __ _-- _ _ _-- -- _-- ❑ ASBESTOS <br /> FACILITY TICKET NUMBER�—_ <br /> ❑ WOOD ` <br /> - SIGNATURE OF AUTHORIZED_AGENT _ DATE_ <br /> - -- - -- - - - - ❑ ASH <br /> O II 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 49695 <br /> MANIFEST# <br />