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WWAKLI WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. c T) M4 .-., 4061 <br />' <br /> GENERATOR- ' <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> WILLIAM S T E W A R T _ _ ❑GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> LUNG ADDRESS_, ' k rz-, _' ❑TY-VEK ❑OTHER <br /> 452 W. LQWELL AVE _ <br /> '^11!�Z —' = �' SPECIAL HANDLING PROCEDURES <br /> CITY,swE„ZIP <br /> TRACY , wCA -95367 <br /> 209-835-5148 <br /> CONTACT PERSON <br /> WILL'I4I4 STEWART <br />' SIGNATURE OFAUTHORIZED AGENT!TITLE - DATE <br /> y� <br /> WASTE TYPE RECEIVING FACILITY <br /> El SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br />■ • ❑ DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br />■ <br /> C] CONSTRUCTION SOIL ❑ ASH ASH <br /> E] OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> J 1' " l i TH (209) 982- 1009 FAX <br /> NAME NOTES I TRUCK NUMBER <br />' 111.ri '4AI L l X3,`1 TSU..<T_'IG <br /> DRESS <br /> CITY, STATE ZIP <br /> F CA <br /> . PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other / <br /> 6 <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 Landfilt 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 If 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 /> ❑ <br /> FACILITY TICKET ASBESTOS <br /> r4t:l BER <br /> - <br /> ❑ WOOD <br /> SIGyNAT/1R OF AUTHORED AGENT DATE <br /> rr/ I ❑ ASH <br /> r ❑ 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 * C 5438 <br /> IGENERATOR COPY <br />