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FORWARD NON-HAZARDOUS WASTE MANIFEST <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. <br /> 1 - - <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C01WC0 Phzih_Ps OGLOVES [-]GOGGLES []RESPIRATOR tj.HARD HAT <br /> ' MAILING ADDRESS ❑TY-VEK [-]OTHER <br /> 76 Bro kiwi_, SPECIAL HANDLING PROCEDURES <br /> CITY,STATE, ZIP <br /> • GacrameiiLj, 1CA 9581£5 <br /> PHONE <br /> 916-558--7633 <br /> ij, CONTACT PERSON <br /> Ed Ra iator, _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE - __1DATE <br /> 1 � <br /> WASTE TYPE 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 /> ' cuLzUco Pr'illlpS V4409 (209) 982- 1009 FAX <br /> 1502 N. EI Dorado SLreeL <br /> Stocktoa, CA <br /> ' NAME _ NOTES _ TRUCK NUMBER <br /> ",1P_ k avironmc.,:t it SL.vvi�_es, Itxc. _ _ <br /> 'ADDRESS <br /> ' P.U. bow 3i%j <br /> •CITY,STATES ZIP <br /> ' _Polo,—CA 95_697PHONE W _ _ __ W _ m ___ END DUMP BOTTOM DUMP TRANSFER <br /> 800-24_5-9518 11 _ __ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(_) _ FLAT-BED VA_-14- DRUMS <br /> lia <br /> ❑ ❑ ❑ <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 R DISPOSEJ BCKPI <br /> IO AERATE STOLE OTHER <br /> waste for any reason If Forwards 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 x ❑ SLUDGE <br /> ARKS <br /> -REM ❑ NON-FRIABLE <br /> _ <br /> FACILITY TICASBESTOS <br /> E] WOOD <br /> KET NUMBER _ <br /> I <br /> S _IGNA— _TURE OF AUTHORIZED AGENT DATE <br /> ( ---- --- - ❑ ASH <br /> ' 7k [❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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 # 76916 <br /> GF:NFRATnP r r)Pv <br />