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WAND �• NON-H/17ARDOUS WASTE MANIFEST <br /> WASTE EATMENT AND DISPOSAL FACILITY <br /> /NC. JOB ACCEPTANCE NO. 5// - SZ/ <br /> GEN OR „p,_ J x- REQUIRED PERSONAL PROTECTIVE EQUIPMENT ,ray <br /> 00- ]GLOVES❑GLOVES [-]GOGGLES [:]RESPIRATOR []HARDHF <br /> MAILING. (] • /3oX ADDRESS _" _ �_' '� ` <br /> ❑ <br /> rLJ�GIs TY-VEK []OTHER <br /> • CITY,STATE,ZIP <br /> - SPECIAL HANDLING PROCEDURES: <br /> • _5ar Ra mcn, cq q Lit _ <br /> PHONE <br /> CgtcG7z- z�lz6 <br /> CONTACT PERSON <br /> 6rardon Haro.s__ <br /> SIGNATURE OF AUTHORIZED AGENT, TITLE DATE <br /> • WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • 0 DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> E) CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY__, .__.; - (209) 982-4298 PHONE <br /> t'UCl �li� Q�I . <br /> Z3oo E (g rnr le�vad (209) 982- 1009 FAX <br /> tvcl�-+an , CA <br /> NAME w. .,s '= NOTES: _ _. _ .. . TRUCK-NUMBER <br /> ADDRESS , <br /> 2s 3 ITY, c) i3_ e r r Ly- rzd <br /> • CSTATE ZIP _ <br /> :�_o n Som <br /> PHONE Xk I END DUMPBOTTOM DUMP TRANSFER ; <br /> �,7Z�( ❑ ❑ _ <br /> SIG _ TURE OF AUTHORIZEDENT OR DRIVER _ DATE LL ROLL OFFS)_ ., FLAT-BED - VAN .T_ DRUMS <br /> * ! ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS - y <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 a 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 _. . �_ DISPOSE 810 _ AERATE JSTCCK�FILE '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 ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. SLUDGE <br /> ra .�_ <br /> • REMARKS_ ,. <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> FACILITxTI <br /> ❑ WOOD <br /> SIG14TIJ O THORIZE AGENT <br /> / % / / ') C/� ❑ ASH <br /> ❑ 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 ARRIVALONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # 3069 <br />