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WARD NON-HA..,tRDOUS WASTE MANIFEST <br /> J WASTE TREATMENT AND DISPOSAL FACILITY <br /> O <br /> INC. JOB ACCEPTANCE NO. I 680911 _ <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> The City of LkAi GLOVES ❑GOGGLES ❑RESPIRATOR ®HARD HAT <br /> MAILING ADDRESS []TY-VEK ❑OTHER <br /> 11.0. Box 3006 <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES: <br /> Lodi, CA 9524121910 None <br /> PHONE <br /> i (20D)333-6800 oxt. 593 <br /> CONTACT PERSON <br /> Gary Wiulan <br /> SIGN OFA AGENT/ TITLE DATE <br /> C c/ wirac ox 4/16/9£ <br /> n <br /> WASTE TYPE Ole 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 FACILITY (209) 982-4298 PHONE <br /> Hutchins Street &quare <br /> 125 8 Hutchins St. (209) 982- 1009 FAX <br /> Lodi, CA 95240 <br /> NAME NOTES: TRUCK NUMBER <br /> Jim 'Rhorpe Oil, Inc. / I <br /> ADDRESS <br /> P.dt Box 357 <br /> CITY,STATE,ZIP <br /> Lodi, CA 95241-03;17 <br /> • PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (209)368-6175 ❑ ❑ ❑ <br /> SIGNATU UTHORI E R DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. L NDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other ApproxiauLely 1.5 <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 �501L- <br /> weather or other site conditions,Forward shall ratify the Disposer when site <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> ` REMARKS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE SAF AUTHO I ED AGENT DATE <br /> � El ASH <br /> 1 n N_ ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIUH to 4:u0 P.m. IliL DAY Pluoli lU LAPLI.t LD AIOaVAI. • Aur oli[ kd aunt LD IOADa ABL <br /> SUBJECT TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVEHIES MI16f BE SCI IEDULEU Willi I I IE I ANDHI 11Ht DAY HLFUHt <br /> TO SCHEDULE CALL(209)982-4298 n 0 p 0 6 <br /> MANIFEST # L O <br /> GENERATOR COPY <br />