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(t)j+0RWAj* - NON-HPORDOUS WASTE MANIFEST <br /> INCORPO,RATED ' - <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> GENERATOR ' ` %-�� ;; .� , �'�; _,�Ex REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> _ r r< ^v;' �7�/Ir 'rL c e r _ __�,., ❑GLOVES �GOGGCES ❑RESPIRATOR []HARD HAI <br /> MAILWG ADDRESS ;�; �r. _ ;_ ❑TY-VEK ❑OTHER <br /> CITY <br /> ''L `� orfs ' SPECIAL HANDLING PROCEDURES <br /> S�A�E - .y _ �' <br /> COI�ITACT PERSON <br /> __- s..•.... <br /> SIGNATUREOF AUTHORIZE AGENT/ TITLE < v DATff <br /> _ _"•, <br /> WAST =TYPE , _ :: v. # ; RECEMNG FACIOT;Y <br /> - -— <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD <br /> CONSTRUCTION 501E ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ ❑ <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAME. ��e.�..�l�k.�.'°k� �e:.:r�s�i.�.��v� Fi �x'�;- OTES- .�ti,-�- *�w`� �r`. �'�_��CK1�1l1MBER'- <br /> I ry,�!'f_5P !? TU4 T <br /> ADDRESS� <br /> CITY,STATE,-ZIP� <br /> PHONE ._ _ v END DUMP =- BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER• DATE '�' � �ROLL-QFS) ;?FLAT-BED My- ✓EVAN r- DRUMS <br /> El <br /> FORWARD INC. LANDFILL cos><c AR 1<- _ <br /> Forward shalt have no obligation to accept the waste if weather or other LI <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED$Y 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 ST LE—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 OIL <br /> conditions are expected to change such that Forward will be able to accep <br /> the waste ❑ SLUDGE <br /> • ,,A�}Rt�. .-fit...- e'-S" '_'s'__ "" s--�_z+.Fa�7,ct^p.�,��...rs <br /> R�I�Y�Nf1S�' r-=Y 1,� y 5._..�.,_r�• _���-3'r..��"'y,��r.b'1*ti f'c.� <br /> ❑ NON-FRIABLE j <br /> ` FACILlTYTICKET 11YMSER'" '-' =�v� -` ASBESTOS <br /> s ,� ,xt , <br /> El <br /> WOOD <br /> SIGNATUR UTFiO f1_f D A~ NT sY-7-__ <br /> -- _ _. [I ASH <br /> 7 , <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO Q 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS AR <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 # 68004 <br /> - sAt t`c rnpv <br />