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FORWAVNON-H RDOUS WASTE MANIFEST <br /> INCORPORA WASTE TWIVIENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> • -GEr �TOR <br /> _ REQUIRED PER ONAL PROTECTIVE EQUIPMENT <br /> GLOVES JE GOGGLES ❑RESPIRATOR [,HARD HAT <br /> m?Ai ADQRRESS / ❑TY-VEK []OTHER <br /> C Y STATE,ZIP SPECIAL HANDLING PROCEDURES: <br /> ' J , <br /> PHONE _ <br /> r�1 C57 r / �� ' U J <br /> CONTACT PERSON �, J <br /> SIGNATURE OFA ONZECP AGENT/)'ITLE DATE � <br /> is - � 'iY��' 7 r;Y,m[f����.� ,r i /� / �! .• <br /> ` WASTE RECEIVING FACILITY` <br /> ❑ SLUDGE <br /> TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> DISPOSAL SOIL [] WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> r <br /> NAME { _ TRACTOR UC. # TRUCK NUMBER <br /> - <br /> ADDRESS ��- � _,..__. <br /> TRAIL LIC.# <br /> 14,x0 �1c�t._ r_j, <br /> CITY,STATE,ZIP TRAILER LIC.# <br /> PVONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZ CI&AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> I ❑ ❑ ❑ . .. _ <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 SOIL <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 <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> ❑ OTHER <br /> SC ECUUNG :NIUST BE MADE PRIOR TC 4:00 P.M. THE DAY PRICK TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE <br /> SUE.- <br /> TO REFUSAL UPON ARRI`/AL. `JC�I`iG ya�L? DELIVERIES SE SCHECULED 'P/#T'-i THE LX111DFILL T�E OAYBEFOREE. <br /> TO SCH=DL-LE CAL 12G9 982-4298 MANIFEST # C 6 5 2 7 6 9 <br /> FoiicsS�iNHIs-ss GENERATOR COPY <br />