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FORWA NON-HP 1Rl _ JS WASTE MANIFEST <br /> 1 ,N C O R P O R A T E D WASTE TrGATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> T;e 1 d on Church ❑GLOVES ❑GOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> 1978 "osemite Read SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE,ZIP <br /> • Berkeley , CA 94707 <br /> PHONE <br /> • 510-524-0297 <br /> CONTACT PERSON <br /> _ 11iam Tittle <br /> SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br /> /Ceologls! , 10 9 S-1 <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> _ ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 1.04 !gest- Beverly <br /> �• Trac_v, CA v (209) 982- 1009 FAX <br /> .. NAME NOTES: TRUCK NUMBER <br /> Bob Evans :'rucrrl.ng <br /> ADDRESS y f <br /> 010 South M2anteca Road C �� <br /> J <br /> - . CITY,STATE, ZIP � { <br /> J <br /> Manteca , CA 9 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> `.`10-239-340- ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> a <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> a <br /> �f' <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 notify the Disposer when site Q SOIL <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 /> SIGNATUREgF/AUTHpRIZED AGT DATE <br /> ❑ ASH <br /> �/ r �� ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR/T¢44:00 P.M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIV NGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # 58003 <br /> GENERATOR COPY <br />