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+ -~ « V-ATE TREATMENT AND DISPOSAL FACILITY <br /> i <br /> . 1,=1VAr., JOB ACCEPTANCE N0. r(T) cmm — 4062 - <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT' - <br /> ❑GLOVES ❑GOGGLES [_]RESPIRATOR ❑HARD HAT <br /> WILLIAM STEWAR7 u �.� y -rrVl��Rbv/ � ❑TY-VEK ❑OTHER <br /> IUNGADDRESS _. - %_.: :�y �._; wr k ..n:M`, y +u.-_- <br /> 452- 'I!. -,O'W E;L L* A-V E,. �_,K, . SPECIAL HANDLING PROCEDURES <br /> �/ �j����ZIP -x- <br /> CI 1 S E <br /> • <br /> -TRACY, CA 953-6.7:�,- �- <br /> PHONE <br /> 209-835-5148 <br /> CONTACT PERSON r__' ' <br /> WILLIAM STEWART <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE BATE �` v L <br /> WASTE TYPE RECEIVG FACILITY <br /> IN <br /> ❑ SLUDGE FORWARD INC. LANDFILL <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS <br /> ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> Ea OTHER MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY (209) 982-4298 PHONE <br /> 1-' 11 T-I 'T (209) 982-- 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> T RUCK1'.u �� <br /> RESS <br /> CITY STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> y_ IU El ❑ 1:1 <br /> SIGNATURE OF'AUTHO�IZED AGPOR DRIVER DATE ROLL-OFFtS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other i <br /> q - <br /> conditions impair the sate 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 DISPOSE BIO AERATE STOCKPILE OTHER <br /> reasonable efforts to promptly notify Disposer of Its inability to accept the <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 s <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NU!� <br /> /1 r ❑ WOOD <br /> 51GIQA JR�lUTHO Z AG T DATE <br /> ,,JR <br /> �A ❑ ASH <br /> ❑ OTHER <br /> CHEDUL MUST BE MADE PRIOR TO 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 5455 <br /> GENERATOFICOPY <br />