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WARDivvlv�al �r�nnuv _ - <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> • r' CMM '4Q61 '� u�'$JOB ACCEPTANCE NO. I(TY ..� <br /> 1 GENERATOR <br /> _ ,rx- ; ,-LL_.x,;� ��-; �, -- _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> WILLIAM STEWART ❑GLOVES []GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> 1�IUNG ADDRESS"' '4 _=*xy r r_��. `'� �R ,x'-, - ❑TY-VEK [:]OTHER452 W. LOWELL AVE . v ;� <br /> CITY,STATF-ZIP f '�"" _``r ' - -"" SPECIAL HANDLING PROCEDURES <br /> _.s ;'� xi�wish": "'^:�tea"..'d.R.-��-'..�i� ��_' .rJ- -z <br /> TRACY,MCA 95367 _ <br /> PHONE -- <br /> 209-835-5146 <br /> CONTACT PERSON <br /> WILLIAM STE'WART TOCfl L <br /> SIGNATURE OF AUTHORIZED AGENT-/TITLE- DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ''` !!'tT j �T ' (209) 982- 1009 FAX <br /> "IA v , CA <br /> NAME NOTES TRUCK NUMBER <br /> ;! -'-4 HA.k1 :!T0N TgUCKT,IG <br /> DRESS <br /> 13? JL1 Ic AVE , LOA) T,=O <br /> . CITY STATE, ZIP <br /> r : r <br /> t )- ri i ,J , r. 7 ^�� s� j r r rrL• �/ Y r f i r�'f + 1 <br /> PHONE END DUMP BOTTOM-DUMP TRANSFER <br /> 73--1100 ❑ ❑ ❑ <br /> SIGNATURFyC7F AUTfORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> / ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL <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 .f 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 1310 AERATE STOCKPILE OTHER <br /> waste for any reason if Forwards refusal to accept the waste is based on <br /> weather or other site conditions Forward shall notify the Disposer when sit SOIL <br /> conditions are expected to change such that Forward will be able to acc$pt- <br /> the waste [] SLUDGE <br /> ` REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE�4/A'UTHORIZED GENT ^5 DAT)r <br /> � ASH <br /> ��r 7--�--- ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIG TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> ITO SCHEDULE CALL(209) 982-4298 MANIFESTO C 5434 <br /> GENERATORCOPY <br />