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r <br /> FORWARD DA <br /> N-HAZARDOUS WASTE MANIFEST <br /> o <br /> I N C O R P O R A T E D WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPT N . - -- k6 ?_7__J <br /> GENERATOR C_ 6 hl WA.1 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> tl- 11) X, -4 ❑GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS_ _ [:]TY-VEK [:]OTHER <br /> ,q;,7 SPECIAL HANDLING PROCEDURES _ <br /> CITY, STATE,ZIP <br /> PHONE f `� <br /> z AJ <br /> CONTACT PERSON J-EF1 i� e) W rU <br /> ""C' 0 Fr i r�f� �r= � 397F� <br /> SIGNATOR OF AUTHORIZED AGENT/ TITLE DATE <br /> do WAST TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ FORWARD INC LANDFILL <br /> TREATMENT SOIL ❑ NON-FRIABLE ASBEST S <br /> DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTIONSOIL ElASH 9999 SOUTH AUSTIN ROAD <br /> s• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-'4298 PHONE <br /> Co> �� i' (209) 982- 1009 FAX <br /> NAME\A/ NOTES TRUCK NUMBER <br /> ADDRESS ' <br /> . CITY, STATE, ZIP <br /> PHONE_ END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATJJRE OF AUTHORIZED AGENT OR DRIVER DATE J ROLL-OFF(S) FLAT-BED VAN DRUMS <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 <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 on <br /> weather or other site conditions, Forward shall notify the Disposer when site ❑ SOIL <br /> • conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS <br /> ` ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER_ ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF A,UTAORIZED AGENT DATE <br /> ❑ ASH <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE; PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL o 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 # <br /> 3, <br /> GENERATOR COPY <br />