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_ `�� ,,,F0R V A NON-HAZ OUS WASTE MANIFEST <br /> �' <br /> f..'N WASTE TRE NT AND DISPOSAL FACILITY <br />' Y1 ., CQRFP.ORATE <br /> JOB ACCEPTANCE NO. 744911- <br /> GENERATOR _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ohmpt 00 , EIGLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> MAILING ADDRESS A - ❑TY-VEK ❑OTHER <br /> i:�3,�i3�ellt Ca+.tr! <br /> CITY,STATE, ZIP SPECIAL HANDLING PROCEDURES: <br /> S.�i:*>S""'Prwk ,CA 5,40aO <br /> - PHONE <br /> f025)97'3-923° <br /> CONTACT PERSON <br /> SIGNATURE O AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> E] DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ <br /> STOCKPILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> "` ' i.._:IJf?s 'w:ns`'y R LIP ON (209) 982- 1009 FAX <br /> NAME TRACTOR LIG. # TRUCK NUMBER <br /> ADpRESSTRAILER LIC. <br /> CITY, STATE,ZIP TRAILER LIC. # <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 34-0374 ❑ ❑ ❑ <br /> SIGNATUff OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS/ice <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 $E COMPLETED$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 STOCKPILEOTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on i_ <br /> weather or other site conditions, Forward shall notify 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 /> I r_� ❑ NON- <br /> O-FRIA LE <br /> ASSTOFACILITY TICKET 1 UMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED A4NT pgTE,- ` <br /> -� , ❑ ASH <br /> ❑ 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 /> 1SCHEDULEO CALL (209) 982-4298 _ <br /> 01 IC6571NH16•p6 SALES COPY MANIFEST # C v l i <br />