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- - _ WASTE TREATMENT AND DISPOSAL FACILITY <br /> � a <br /> ' JOB ACCEPTANCE N0. (T) CMI <br /> GENERATOR _ ._f-" ::, «y'L f %r."a'�.:- _ REQUIRED eERS0NAj,,PFi6TEtnWWUIPMENT <br /> WILLIAM �STE_WART []GLOVES ❑GOGGLES ❑RESPIRATOR E]HARD HAT <br /> NG ❑TY-VEK <br /> M ❑OTHER _ <br /> 452 W. LOWELL AVE. <br /> CITY STATEr ZIP - � T =}`` -" - ,L SPECIAL HANDLING PROCEDURES <br /> is ' -. :.ice :.%rte.t <br /> } TRACY ~ CA 95367 s _ <br /> PHONE "_ , . -'�:- -•, s-�. ���-. :Y, -�-,'.; .. _, <br /> tier, <br /> ` 209-835-5146 -- <br /> CONTACT PERSON' <br /> WILLIAM STEWART — <br /> SIGNATURE OF AUTHORIZED AGENT/"TITLE -,-�' DATE ) r I L <br /> WASTE TYPE RECEIVING FACILITY <br /> I ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> E . ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> .• Q OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> � yJ °I • �1f;t sT • (209) 982- 1009 FAX <br /> TrlAC'/ , C : <br /> NAME NOTES TRUCK NUMBER <br /> A,11TLJ;,' TR:;C' <br /> DRESS <br /> ia' 7 .1 <br /> 12�8 ?,aL1LI,LI- AVE . L�� <br /> . CITY STATE ZIP <br /> ��-�S SCA ��C5� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATYRE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> -olr _ 'r <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 DISPOSE BIO AERATE STOCKPiiE OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the <br /> waste for any reason If f=orwards refusal to accept the waste is based on SrOIL <br /> weather or other site conditions Forward shall notify the Disposer when , <br /> conditions are expected to change such that Forward will be able to a ept _ <br /> the waste ❑ SLUDGE <br /> REMARKS <br /> o NON-FRIABLE= <br /> ASBESTOS <br /> FACILITY TICKET NUMB�EJR ❑ WOOD <br /> SIGN�AQOF HORYLED EtrLT DATE <br /> ❑ ASH <br /> / ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR T014 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL O� GOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209) 982-4298 t MANIFEST # C 5456 <br /> GENERATOR COPY _ - `- _- <br />