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F®WARD NON-HAZARDOUS WASTE MANIFEST <br /> �b INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> J013 ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> j pq � + y � �� [_]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> l� C- {�' � ' `� art SPECIAL HANDLING PROCEDURES -� <br /> CITY,STATE, ZIP _ <br /> x4—)) <br /> i !/i J r ,p.� r,ri✓i��I L.' `s I 4. <br /> PHONE <br /> CONTACT PERSON 5- <br /> I U9 <br /> 'IU9 ,7142 k- t / 1r ✓r � <br /> SIGNATURE OF AUTHORIZED AGENT/ TITLE DATE ff <br /> u ' <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ 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 /> (209) 982- 1009 FAX <br /> �� ! � ��~ !T�'��= =`.� r'I" Gyp j� f C-�,�• <br /> r NAME ^�" t } , NOTES TRUCKUMBER <br /> ADDRESS <br /> . CITY, STATE, ZIP <br /> f <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> . SIGNATILJRE OF AUPORIZ�D AGENT OR E <br /> DRIVER DAT ' ROLL-OFFTS) FLABED 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 DISPOSE BIO AERATE STOCKPILE OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the <br /> waste for any reason If Forward's 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 <br /> ■ NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE-OF AUTHORIZED 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 <br /> MANIFEST "J <br /> T sPK48PORTEF= CCPy <br />