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l,OR ~-" MON-HAZA AN <br /> WASTE MANIFEST <br />• �-►a �!-N C O R D O R'A T D - WASTE TREAMENT AND DISPOSAL_)✓ 14CILITY <br /> � . <br /> JOB ACCEPTANCE NO. [:7:-44911 <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C!_.xr :t�5 Oil ®!GLOVES []GOGGLES ❑RESPIRATOR ©HARD HAT <br />' MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> -> <br /> 2,0 <br /> CIT ,SJ TATE. IP SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE;ZIP ' <br /> • fr,sth a�FrML63CO;CA 940BO <br /> PHONE <br /> (92__:873-9238 <br /> _ K <br /> CONTACT PERSON i �';. 1 J <br /> SIGN QF AUTHO�i17fED GENT /TITLE DATE <br /> +J` , I <br /> WASTE TYPE RECEIVING FACILITY ~s ¢ <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • E] DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ STOCK PILE _ ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982•- 1009 FAX <br /> NAME - - --_.--..•,_-_ ..---'-- TFtACTORLIC.#!r ,-1_"-'c - -?-TRUCK NUMBER- <br /> ADDRESS TRAILER LIC_ # <br /> • CITY,STATE,ZIP TRAILER LIG. # f is ,trt <br /> PHONE ENq 1>UMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> j r ❑ ❑ ❑ ❑ <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 effective operation of the Landfill. Forward shall use DIOSE BIO AERATE ISTOCKPILE 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 <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 accepl— <br /> the waste. [3SLUDGE <br /> REMARKS <br /> a <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER',~ ASBESTOS <br /> J E] WOOD j <br /> SIGNATURE O�AUTHORIZED]AGENT_. <br /> E] ASH - <br /> 7�' •� ; ! �- ❑ OTHER !. <br /> SCHEDULING MUST BE MADLY 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 BEF--ORE. <br /> TO SCHEDULE CALL (209) 982-4298r. <br /> F01 JC951INH16.56 SALES COPY MANIFEST # C 6 6? "til 9. <br />