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- YII TY <br /> � WASTE�FREATMENT AND DISPOSAL FACILITY <br /> 1�.MC. JOB ACCEPTANCE N0. j(T,7,C11wf- lloCl - �* 3 2-,,5- Z-C) <br /> GENERATOR' F ' - , , s REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> �I�aM ` y,t <br /> El GLOVES ❑GOGGLES ❑RESPIRATOR E3 HARD HAT <br /> IL1NG ADDRESS -"- r V - , w _ ❑TY-VEK ❑OTHER <br /> ys-;z V, SPECIAL HANDLING PROCEDURES <br /> _ - - i ° - I - - - - <br /> CITY vP <br /> STATE; <br /> PHONE -- <br /> ' <br /> CONTACT PERSON , <br /> SIGNATURE OF AUTHORIZED AGENT/TTTLE DATE <br /> ., <br /> WASTE TYPE RECEIVING FACILITY <br /> r_1 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 /> r v �,1 Sr (209) 982- 1009 FAX <br /> I r�rC f/> <br /> NAME NOTES TRUCK NUMBER <br /> /6C/7 Ce,77; <br /> DRESS <br /> J t <br /> . CITY STATE, ZIP <br /> .;PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ^; <br /> SIGNATURE OF A4THORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste it 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 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 <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 aeceat— <br /> the waste ❑ SLUDGE <br /> REMARKS <br /> NOIV-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ---I /AGENT <br /> WOOD <br /> SIGNATURE Ot,AUTHORIZEDf� DATE <br /> / i ASH <br /> �J ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR-�4 O 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 /> ITO SCHEDULE CALL (209) 982-4298 GENERATOR COPY MANIFEST # C 5474 <br /> - - �� - <br />