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���� 1VViV—nr►�r-+nuVV�7 YYr'►o1 c tv,ry v„ ,..v, <br />' �A•, WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. T) _CM - �.4osr; 'r . <br />' GENERATOR ,_ t _.-� REQUIRED PERSONAL PROTECTIVE EQUIPMENT. s <br /> WILLIAM STEWART,_rw ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ILING ADDRESSSR _�! ❑TY VEK []OTHER <br />' 4521 W. LOtWELL AVE., _.,__ .._ -,���,^ ��— - SPECIAL HANDLING PROCEDURES <br /> CITY,STATE, 2JP <br /> • TRACY, CA 95367 A,n„. <br />' - PHONE <br /> ry/ <br /> 2 [(0J-—835-514 <br /> = p <br /> • [i <br /> CONTACT PERSON <br />' WILLIAM STEWART - <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE _ S77 X)6 i L �- <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 />' <br /> ;-15 ,IS T . (209) 982- 1009 FAX <br /> T; il;Y , CA <br /> AME NOTES TRUCK NUMBER <br /> H41 1ILTJ, TP,IJC4I,;'G <br /> ADDRESS <br /> • 133S PAYL'IG ails . ,a 3C <br /> • CITY,STATE ZIP <br /> e T yip .A 357 53 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> _ ❑ Cl ❑ ❑ <br /> _ - ' <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL r <br /> Forward shall have no obligation to accept the waste if weather or other r �' <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSALN�EPI=IOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shalt use <br /> reasonable efforts to promptly notify Disposer of its onabiWy to accept the DISPOSEJ SIO AERATE STOCKPILE OTHER <br /> I 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 / ❑ SLUDGE <br /> REMARKS <br /> NON-FRIABLE <br /> ❑ <br /> ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> - SIGN,AT�RE,OF^THORIZEP`AGENT DATE <br /> � DASH <br /> ��- // I ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR-JO 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 # 27697 <br /> GENERATOR COPY <br />