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FORWAP I) NON-HA'gRDOUS WASTE MANIFEST <br /> �b 1 N ( 0 R P.0 R A ?"K 1) WASTE K-.eATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. - /341 1 ' <br /> i y+ : <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ar ',• ;;�,�j_'> ❑GLOVES [-]GOGGLES []RESPIRATOR []HARD HAT <br /> MAILING ADDRESS ❑TY-VEK []OTHER <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES: <br /> PHONE <br /> CONTACT PERSON <br /> r?E , _ 0 vT/i <br /> SIGNATURE OF AUTHORIZER AGENT/ TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> ` ❑ DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> El CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ''(� F HAA, v`UChT� (209) 982- 1009 FAX <br /> JC4 <br /> NAME NOTES: TRUCK NUMBER <br /> 4-14411ey yo"a C 06 <br /> �tU_'fr.'ti6 i Q L2sS ,4 o ('A <br /> �i/✓:t/I <br /> ADDRESS f{ f <br /> �V _Pei ttr e zr, re 5113 <br /> . CITY,STATE,ZIP <br /> 0 <br /> -J S C r pia .c.'*J <br /> PHONE END DUMP ♦Y� BOTTOM DUMP TRANSFER <br /> _ SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 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 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 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 ratify the Disposer when site ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> I -- <br /> the waste. ❑ SLUDGE <br /> ` REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF;VJ,1'6O9IZED AGENT DATE <br /> ❑ ASH <br /> J . .... _. /'— /a' .—` ❑ 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 MANIFEST -1 el n n <br /> 7 {l <br />