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ri 0 \ L y � 1 <br /> NON-HAZA OUS WASTE MANIFEST <br /> I C O R P O R A T E -D WASTE TREATMENT AND;'DISPOSAL FACILITY l <br /> a <br /> : JOB ACCEPTANCE NO. - <br /> r <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT. <br /> � � <br /> ❑GLOVES [:]GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> AVAILINGDDtESS '�- ❑TY-VEK ❑OTHER <br /> SPECIAL HANDLING PROCEDURES: } <br /> P 'CITY,S?A7E,ZIP <br /> • �I Okcll L/)1l,'_ , C4. 2W I(l <br /> I <br /> f2 .? <br /> &ONTACT 6 SON I <br /> i <br /> SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br /> )NAS7E TYPE_ - f RECEIVING FACILITY <br /> I <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD 4 <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ STOCK PILE ❑ OTHERMANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ro (W lj �� s - (209) 982-1009 FAX r <br /> 7•'/'f.I ( Y CA '!� E _ 76 <br /> TRACTOR LIC.# �-I� p TRUCK NUMBER <br /> ' i <br /> NAME - �,,, _,�, S � �,j 1 5 (ly ,'C'1/� °a, h ; <br /> ADDRESS <br /> , r TRAILER LIC.# -�TS <br /> �- .., r- r � � - <br /> . C1T;-Y,STATE,ZJP <br /> -� TRAILER LIC-# <br /> UJ <br /> . PHONEEND DUMP BOTTOM DUMP TRANSFER <br /> -� <br /> . SIGNATUROF AUTHORIZED AGENT OR DRIVER DATE ROLL-0FF( ) FLAT-BED VAN DRUMS <br /> y CUBIC YARDS <br /> FORWARD INC. LANDFILL i <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 13E COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill, Forward shall useD1$POSE 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 P401L <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 ❑ SLUDGE <br /> the waste. <br /> REMARKS x . . _ NON-FROLBLE <br /> ASBESTOS + <br /> FACILITY TICKET NUMBER WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ASH <br /> -9111 <br /> f + <br /> 1 7 <br /> i <br /> / OTHER <br /> SCHEDULING MUST MANE PRRIO ONGOING DAILY DEL VERIES MUST BE SE DAY PRIOR TO CHEDULED ED WITH THE LANDFILL THE DAY BEFORE. <br /> D ARRIVAL a ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSALL UPON AR <br /> 209 982-4298 T # C -7 <br /> REDUCE CALL Mi4NlFES <br /> TO SC ( ) COPY <br /> j F0(G9511NH)5-9S SALES CO ( 05752 <br /> � <br /> I }}I <br /> 5 <br />