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' WARD WASTE TREATMENT AND DISPOSAL FACILITY <br /> if <br /> JOB ACCEPTANCE NO. (T) CIM --4061 <br />' GENERATOR - __ - t_ , ; �-t �., :,moi was,w - z,.- REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> WILLIAM STEWAR_ T _ _ _ []GLOVES ❑GOGGLES ❑RESPIRATOR [--]HARD HAT <br /> ILIIVG ADDRESS - : xri __�4,law i��F'W __ ❑TY-VEK ❑OTHER <br />' 452 W. LOWELL AVE. f SPECIAL HANDLING PROCEDURES <br /> CITY,STATE;ZIP L <br /> _,.�•�. .LnY.,?:.`. <br /> TRACY, CA 953'67 Y <br /> PHONE _ _ <br /> 209-835-5148��;Ly <br /> CONTACT PERSON _ ,� - - T' « `F ^ r : <br /> w ' ��-TD GlePIL f, <br /> WILLIAM STEWART <br /> SIGNATURE OF AUTHORIZED AGENT C TITLE -[DATE ' <br /> .. * <br /> WASTE TYPE - RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ DISPOSAL 501E ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> © OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 3 i w . 3i r ' _33 <br /> CA (209) 982- 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> r,I -ILI Hl`jTi T=^`, T ;UCCI61r <br /> DRESS <br /> 133 ?AUL T,k1E Atillr - L 7 AJ 71 <br /> - CITY STATE ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> � 1 _ 11 ❑ ❑ ❑ <br /> _ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other <br /> Is— <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 810 AERATE STOCKPILE OTHER <br /> waste for any reason It Forwards refusal to accept the waste is based on <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 /> FACILITY �C MB <br /> ETNI ER <br /> ASBESTOS <br /> / f /�� ❑ WOOD <br /> 61(C VAT7U &AUT AIZFD AGENT / ; DATE <br /> 1 / ❑ ASH <br /> 2 <br /> r <br /> 7`�L��d[] OTHER <br /> CHEDULING MUST BE MADE PRIOR TO k,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 /> ITO SCHEDULE CALL (209) 982,4298 MANIFEST # C 5433 <br /> GENERATOR COPY <br />