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NON-HA �RDOUS WASTE MANIFEST <br /> F 0 RWA P <br /> Vo , I N C O R P O R A T'P-wD WASTE T r,-ATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. — <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> V,'eldon Church E]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS - ❑TY-VEK ❑OTHER <br /> 1958 Yosemite Road <br /> CITY, STATE, ZIP SPECIAL HANDLING PROCEDURES: <br /> • Berizeley, Cry 94707 <br /> PHONE <br /> 7-10-524-0297 <br /> CONTACT PERSON <br /> ',-ill iaint Little <br /> SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br /> jGCalociSt <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 <br /> lo^ }e=t. �.e-�rerl;r (209) 982-4298 PHONE <br /> Trac,, , CA (209) 982- 1009 FAX <br /> NAME NOTES: TRUCK NUMBER <br /> POh Fva i3,,_ _.'rucking <br /> ADDRESS •� ��_, <br /> 21010 SOSouthMt3nteC? 1�07C CD <br /> • CITY,STATE, ZIP x <br /> "anteca, CA 953317 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-239-3407 ❑' ❑ ❑ <br /> SIGNATURL OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> '~--- ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS 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 <br /> impairs the safe and effective operation of the Landfill. Forward shall use DISPOSAL METHOD: (TO BE COMPLETED BY FORWARD) <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 �'JUJLJ <br /> conditions are expected.to change such that Forward will be able to acceAt� <br /> the waste. ❑ SLUDGE <br /> • <br /> REMARKS <br />... ' ❑ NON-FRIABLE <br /> FACILITY-'PICKET NUMBER ASBESTOS <br /> ❑ WOOD <br />_ - SIG)UTURE 911` AUTHORIZED GENT f DATE <br /> I ❑ <br /> � ASH <br /> , <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIORI T0-4 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 # 57804 <br /> GENERATOR COPY <br />