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�a■, ._.,ter-='A.�;. , . -:�.HAZiO1S �STE.II�ANIFES �R <br /> r_ V. A i 1 Alt �-� O� F. <br /> WASTE TRTMEiVT AND ISPOSA�FACILfTI'� <br /> V►� ' rNCORPORATED , <br /> . -` - JOB ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAC_PROTECTiVE EQUIPMENT---.w---.--._-- <br /> r} <br /> []GLOVES ❑GOGGLES [_—]RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS J , _ ❑TY VEK ❑OTHER <br /> SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE,ZIP <br /> PHONE <br /> CONTACT PERSON <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> I <br /> ' r <br /> WASTE TYPE _ RECEMNG FACILITY <br /> ❑ SLUDGEi <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL 0 A HER <br /> bitMANTECA, CALIFORNIA 95336 <br /> GENERATING:FACILITY �. .._ (209) 982-4298 PHONE <br /> Ku.. . ...� 209 982- 1009 FAX <br /> T -t !7 r9. .s <br /> - NOTES: -TRUCK NUMBER <br /> GAME �r' Ca xm _ f _ f I <br /> ADDRESS a> ui°aaa.w, r�Lv r;fh <br /> . CITY,STATE,ZIPu f_ <br /> BO <br /> TTO <br /> MDUMP TRAN <br /> SFE <br /> R <br /> END DUMP <br /> PHONE <br /> • <br /> ❑ <br /> ' S FLAT-BED : VAN DRUMS <br /> FF <br /> NT,` RIVER DATE <br /> .. 'ROLL-OFF(S)) <br /> SIGNATURE OF AUTI�-ORIZED AGE .. _ ", ❑ Q ❑ ❑ <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL i <br /> Forward shall have no obligation to accept the waste if weather or other g COMPLETED BY FORWARD) {; <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD: (TO' E� <br />` impairs the safe and effective operation of the Landfill. Forward shall use1 6iSPOSE SIO "• AERATE ,OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the <br /> waste for any reason. ff Forward's refusal to accept the waste is based on <br /> n site <br /> weather or other site conditions,For <br /> sw�ard Fnotify <br /> Nt ardt Ihe � to accept <br /> ,.conditions are expected to change ❑ SLUDGE <br />{ the waste. I <br /> G ` REMARKS NON-FRIABLE t <br /> w* ❑ ASBESTOS <br /> NUMBER <br /> FACILITY TICKET. :h>K .wix a <br /> i w ❑ WOOD <br /> i _ . . <br /> SIGNATURE OF AUTHORIZED AGENT_ <br /> DATE- <br /> SIGNATURE ,� .., <br /> i .-1 ❑ ASH <br /> OTHER <br /> Y UNSCHEDULED SCHEDULING MUST BE MADE PRIOR TO :00 P-M. OR TO EXPECTED ARRIVAL AN <br /> THE Dil ERIIES MUST BE SCHEDULED WITH THE LANDFILL THE DI1Y0 BEFORE <br /> SUBJECT TO REFUSAL UPON ARRIVAL.ONGOING DAILY DE <br /> h TO SCHEDULE CALL(209)982-4298 MANIFEST # 10884E, <br />