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V4ISTE TREATMENT AND DISPOSAL FACILITY <br /> IWWARU <br /> JOB ACCEPTANCE N0. f(T) CM14- 4061_, �r <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> WILLIAM STEWART ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> NG ADDRESS <br /> w y,c '�µ�isv mac:: � •- ,_ mss„ ❑N-VEK ❑OTHER <br /> 452 W , L O W E L L AVE`. ---n SPECIAL HANDLING PROCEDURES <br /> CITY STATE;ZIP _ _ gat:. 7t� <br /> • TRACY, CA 95367 <br /> PHONE <br /> 209-835-5148 <br /> CONTACT PERSON v W _ -' _ <br /> WILLIAM STEWART <br /> SIGNA/TUREOF AUTHORII�ZED�AGGENT/TITLE DATE I&P 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 /> p OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY , (209) 982-4298 PHONE <br /> r y" 11 TI-i `3 l ' (209) 982 . 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> tyL !T Jfi t - 1 f J <br /> v c.i s <br /> RESS <br /> C ., . <br /> . CITY, STATE ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> • —L-•=J , ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) 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 f <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 o ❑ ^ <br /> weather or other site conditions Forward shall notify the Disposer when e 1§0 IL <br /> conditions are expected to change such that Forward will be able to acc <br /> lepl— <br /> the waste ❑,SLUDGE <br />` REMARKS <br /> NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICfSF�T NJAQBER <br /> WOOD <br /> SIGHSIGNATURE <br /> TUREQF AUTHORIZED AGENT f .j DATE ❑ ASN <br /> 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 /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # C 5453 <br /> GENERATORCQPY -- - ---- - -- - -- - - - - r--- - <br />