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lj%!WARD <br /> - �rv}aly-n�,ynvWASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> I (T) CMN4'-' 406 - <br /> GENERATOR ,, „ ( REQUIRED PERSONAL PROTECTNE EQUIPMENT <br /> WILLIAM STEWART _ ❑GLOVES ❑GOGGLES ❑RESPIRATOR E]HARD HAT <br /> LING ADDRESS ,p` s 5-" �;��~` ��__ _ :�M�i _ ❑TY-VEK ❑OTHER <br /> 452 W.ADDRESS.-,, <br /> CITY STATE,ZIP ° Y s� ° - w, _,'= j'T = SPECIAL HANDLING PROCEDURES <br /> TRACY , CA 93367 _ <br /> PHONE - " _ K u <br /> 209-835-5148 <br /> CONTACT PERSON <br /> WILLIAM! STEWART N7 n ' <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE C, ��, 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 /> ' " , 1` - ST' (209) 982- 1009 FAX <br /> T�9zy 4 <br /> ME NOTES I TRUCK NUMBER <br /> RIC,] <br /> DRESS <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 /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other y �s <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 mabihty to accept the DISPOSE 810 AERATE STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on SOIL <br /> f� <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 /> SIGNATYRE OF AUTHORIZED AGENT DATE <br /> �� - ,—� ❑ ASH <br /> I�-`�i t - -`�� ❑ OTHER <br /> CHEDULING 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 /> O SCHEDULE CALL (209) 982-4298 MANIFEST # C 5445 <br /> GENERATOR COPY <br />