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WASTE TREATMENT AND DISPOSAL FACILITY <br /> J"NC. 's6 9 <br /> JOB ACCEPTANCE NO, (T) CMM �-4061 , ; -=h <br /> 33,aS -U <br />' <br /> GENERATOR _ u �;. < - - '1 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> � �,r.., �.. t ._• . 4.�_., _ <br /> WILLIAM STEWART _ _ E]GLOVES E]GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ILING ADDRESS '_ -*s� "�T ��•�; ' ❑TY-VEK ❑OTHER <br /> 452 W . LOWELL STATEAHE, _ _ _ _ <br />' CITY, '.ZIP � - s�"_ SPECIAL HANDLING PROCEDURES <br /> aTRACY, CA 95367 <br /> PHON �~� } _ L <br /> ES t <br /> 209-835-5148 <br /> CONTACT PERSON <br /> WILLIAM STEWART kpl LC <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE pG <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 /> _11-ii Sr ' (209) 982- 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> RAj, .i r1A,`,i1LTJ,4 I RUCK1,IG <br /> I ;� f E Zlp�L�,Ll,.L AVE . 1 ?� <br /> CITYSTAT - <br /> 1 LJ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> /'/' ❑ ❑ ❑ El 1 <br /> FORWARD INC. LANDFILL CUBIC YARDS <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 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 STOCKPILE OTHER <br /> waste for any reason if Forwards refusal to accept the waste is based on 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 acce <br /> the waste [] SLUDGE <br /> REMARKS <br /> o NON-FRIABLE <br /> FACILITY TICKET NUMBER <br /> ASBESTOS <br /> � ❑ WOOD <br /> SIGNAT,JRE OF A&HORIZEQ A NT' DATE <br /> _ r �_ ❑ ASH <br /> -�� �` �� ❑ OTHER <br /> CHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> UBJECT 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 5449 <br /> GENERATOR COPY <br />