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t NON-HAZARDOUS WASTE MANIFEST <br /> WARDWASTE TREATMENT AND DISPOSAL FACILITY <br /> QVE,. JOB ACCEPTANCE NO. CMM — 0967 <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Fred e r, C x Mayers []GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ❑TY-VEK [:]OTHER <br /> 1833 Robin Lane SPECIAL HANDLING PROCEDURES <br /> ' CITY,STATE, ZIP <br /> Lodi., CA 95240 <br /> PHONE <br /> ( 209 ) 368-6495 <br /> CONTACT PERSON <br /> Frederac.k Mayers <br /> SIGNAT HRE OF,AUT-kl RIZED AGEKT / TITLE DATE <br /> 7-13-94 <br /> ` �f�/ ` ✓ L'/ p <br /> WASTE TYPE r I 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 /> 4 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> X26 Soutt1 Street , Lodi-, C11 (209) 982- 1009 FAX <br /> " NAME NOTES TRUCK NUMBER <br /> y° Lco L',, snti Trucking - -� <br /> ADDRESS <br /> ? L0 j 0 uth Ya11t e a hoa,,' <br /> CITY, STATE, ZIP <br /> r:un eta , Cry 9``133 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> k209 ) 23cr-3407 lu ❑ Z <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> , <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 effectkve operation of the Landfill Forward shall use <br /> seasonable efforts to promptly notify Disposer of its inability to accept the ] DISPOSE 1110AERATE S70CKPrLE OTHER I <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- <br /> '190 <br /> conditions are expected to change such that Forward will be able to accept I <br /> ' the waste ❑ SLUDGE <br /> REMARKS NON-FRIABLE <br /> ❑ ASBESTOS i <br /> FACILITY TICKET NUMBER V <br /> ' ❑ woOD I <br /> SIGNATURE OF AUTHORIZED AGENT j DATE <br /> ❑ ASH <br /> a I ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE <br /> ' TO SCHEDULEREFUSAL CALL {09ON ARRIVAL <br /> ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO <br /> MANIFEST # 27922 <br /> SALES COPY <br />