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WASTE TREATMENT AND DISPOSAL FACILITY <br /> IIA/r. ... N �dU6 <br /> JOB ACCEPTANCE N0: (T CM4 <br /> ) , •- ,�^,, <br />' GENERATOR - _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> WILLIAM STEWART _ [:]GLOVES ❑GOGGLES [:]RESPIRATOR [:]HARD HAT <br /> LING ADDRESS �,a';�: -�-„ _ -_ r ❑TY VEK ❑OTHER <br /> 14 5 TE. P 2t Lfl W E L <br /> CITY,STAT -yy�, �m_,�w w,r SPECIAL HANDLING PROCEDURES <br /> „r_.�..L.��''. _�- r�';�.�....«_ <br /> • TRACY, CA 95367 - <br />' - PHONE <br /> 209-835-5148 ,,-' <br /> CONTACT PERSON <br /> WILLIAM STEWARTC L <br /> _ <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE_ if <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 /> I <br /> ~I] I,!. 11TH (209) 982- 1009 FAX <br /> T'laCY , CA <br /> NAME NOTES TRUCK NUMBER <br /> ILT,; 1 TRJC<I IG .-Z <br /> DDRESS <br /> i 1il� aVE . �tir+J Tn <br /> _- CITY STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> V - ❑ ❑ ❑ <br /> _♦ 'J' -'�1JJ <br /> SIGNATURE OF AUTHORIZED AGENT OIj��VER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other J r <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 S70GKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on I�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 /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER �-- <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZE'AGENT DATE _ <br /> / f� '�? /�;��i ❑ ASH <br /> _ r <br /> �r __ �� rr� ❑ 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 <br /> BEFORE <br />,TO SCHEDULE CALL (209) 982-4298 MANIFEST # 27698 <br /> GENERATOR COPY <br />