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- I NON-HAZARDOUS WASTE MANIFEST <br /> 1 NCO R P O R A T E D d WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. 74571f <br /> GENERATOR x REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 02 Petral-um ©GLOVES [:]GOGGLES ❑RESPIRATOR ®HARD HAT <br /> ILING ADDRESS ❑TY-VEK ❑OTHER <br /> 191 Narv:>.+m <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES <br /> SogCA 95206 <br /> PHONE <br /> CONTACT PERSON <br /> ' SIGN/AT JUJZ OF AUTHORIZED AGENT/TITLE DATE ' <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> I ' ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> ` © DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ STOCK PILE ❑ OTI,ER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 912NfoZiz$nd Ntk\'__P'CA (209) 982- 1009 FAX <br /> AME TRACTOR LIC # TRUCK NUMBER <br /> 7:*41 Trad-=1 rpt+ <br /> ADDRESS TRAILER LEC <br /> Poll Crfficc BC ri9 "(')I- 1 <br /> • CITY,STATE,ZIP TRAILER LIC , <br /> P 13r--4C A 934!4 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> a"25)634,03'4 -Eil- ❑ ❑ <br /> SIGNAT R OF AU .JORJZED 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 t'1e waste if weather or other 4 <br /> conditions impar the sate and etfeclive 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 <br /> reasonable efforts to promptly notify Disposer of :ts mab,ltty to accept theDISPOSE BIO I AERATE STOCKPILE OTHER <br /> waste for any reason If Forward s refusal 10 accept the waste is based on <br /> weather or other site condit*ns Forward shall n;,tdy the Disposer when site SOIL <br /> conditions are expected to change such that Forward will be able to accept. <br /> the waste <br /> SLUDGE <br /> REMARKS ❑ <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS- <br /> ❑ WOOD <br /> SIGNATU E¢F AUTHORIZED GEPT DATE <br /> f J;�� ASH <br /> OTHER J� ❑ OTHER <br /> CHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> SCHEDULE CALL (209)982-4298 x O F <br /> e <br /> {C9611NH)6 96 GENERATOR COPY MANIFEST# C688990 <br /> 1 <br />