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FORWAR 9 NON-HAS' - gDOUS WASTE MANIFEST <br /> I N C O R !' O R A T 2"b WASTE T �TMENT AND DISPOSAL FACILITY <br /> J JOE ACCEPTANCE NO. �- - 4638 <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S RE INC [:]GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD-HAT <br /> MAILING ADDRESS ❑TY-VEK [:]OTHER11828 DUBLIN BLVD. <br /> CITY STATE ZIP ' <br /> SPECIAL HANDLING PROCEDURES: <br /> DOBLIK , CA 94568 i <br /> PHONE <br /> ( 510 ) 829-8491 ' <br /> CONTACT PERSON <br /> ` DON ROFF11,4AN <br /> SIGNA34�E OF AUT O.R�Z E GENT/ TITLE DTE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL <br /> ❑ CONSTRUCTION SOIL 0 SH 9999 SOUTH AUSTIN ROAD <br /> .. 1 <br /> • <br /> El OTHER MANTECA, CALIFORNIA 95336 <br /> GENE ffpp FtC,VTY (209) 982-4298 PHONE <br /> A 1CLOVER ROAD <br /> TRACY , CA (209) 982- 1009 FAX <br /> I <br /> p�E <br /> N DIANLEY &; SONS TRUCKING INC. NOTE B <br /> -''. .W. <br /> ��ss TRUCK NUMBERF <br /> E , <br /> AD�69V ELDEF ' CFF,EI: . ROAD A/)` <br /> �- <br /> . CITY,�STATE,ZIP <br /> Y <br /> SACRAMENTO CA 95826 <br /> PHONE <br /> 91 G) 3$ -CSG 4 END DUMP,.: _­BOT,TOMyD,UMP k TRANSFER 4 <br /> �h ..._ ❑ ❑ <br /> SIGNATI}RE�/ AUTHORIZED AGENT OR DRIVER DATtE -7 ROLL-OFFS FLAT-BED VAN <br /> El <br /> t <br /> FORWARD INC. LANDFILL euBICYARDs 13' YARDs <br /> : i <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: MPLTED BY <br /> ' (TO BE-COEFORWARD <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 kvOTHER <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 ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. <br /> ❑ SLUDGE <br /> REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZE,AG T DATE <br /> ❑ ASH <br /> IZ07.r ❑ OTHER � <br /> i <br /> I <br /> HEDULING MUST BE MADE PRIOR TO 4:00 P.M. THE DAY PRIOR TO EXPECTED ARRIVAL ANY UNSCHEDULED LOADS ARE <br /> 3JECT TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. j <br /> .� SCHEDULE CALL (209)982-4298 TRANSPORTER COPY MANIFEST# C 11500 `� <br />