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WAR9, '` t �M ' — IVASTE TREATMENT AND DISPOSAL FACILITY <br /> J= 1vAlr. JOB ACCEPTANCE NO. (T) CMM — 4061ti *6,__- <br /> GENERATOR _. _ •`� - �� _ - `='n • =c REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I L L I A M S T E W Ali Tn _ _ _ ❑GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> IUNG ADDRESS y, _ - _ k` `= Ys+ ❑TY-VEK ❑OTHER <br /> 452 -W . L O W E L L. AVE . , ,_ ; _ - SPECIAL HANDLING PROCEDURES <br /> CfTY,STATE.ZIR _ Y�-.ti._::_1V <br /> TRACY ,_ CA 95367 <br /> PHONE <br /> ` 209--835-5148 <br /> C04ACT PERSON ,- ,, _- <br /> 14ILLI;AM STEMART <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE FORWARD INC LANDFILL <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS <br /> • ❑ DISPOSAL SOIL ❑ WOOD 999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ASH <br /> � OTHER <br /> MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY (209) 982-4298 PHONE <br /> Tia (209) 982- 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> 14 I;TI-9 i T73UC<T 116- <br /> DRESS <br /> lrDRESS ' PI <br /> JI - - <br /> . CITY, STATE ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ; ,_ E ❑ ❑ <br /> SIGNATURE OF,AUTHORIZED AGENT OR ;RWER DATE ROLL-OFF(S) FLAT-BED VA DRUMS <br /> El <br /> FORWARD INC. LANDFILL cuelc 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 sf the waste DISPO 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 site ' <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS Ei NON-FRIABLE <br /> ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNAT-LIRE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> �Y -- I ❑ OTHER <br /> SCHEDULING 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 GENERATOR COPY MANIFEST # C 5457 <br />