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ORWARYs - ICON-HAZA US WASTE MANIFEST <br /> WASTE TREA-1WNT AND DISPOSAL FACILITY <br /> INCORPORATED <br /> - - -JOB ACCEPTANCE N0. 1744911 <br /> GENERATOR' , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ' i;�m €anoi! GLOVES [:]GOGGLES []RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ❑TY-VEK []OTHER <br /> 061'isu,e court SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE,ZIP- <br /> ' • Swtts San ftazzjnc,CA 94080 <br /> PHONE <br /> ( 25 i S^s-9x?R <br /> CONTACT PERSON <br /> SIGNATZIJ OF AUTHORIZED AGENT/TITLE DATE <br /> kk - <br /> WASTE TYPE. RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ STOCK PILE [] OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> F�=r:y>` �z�I:stiycy �� y�3 (209) 982- 1009 FAX <br /> NAME TRACTOR LIC. # r ' TRUCK NUMBER <br /> AD6AESS7 TRAILER LIC. # <br /> - CITY,STATE, ZIP TRAILER LIC. # <br /> A 414 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> 7k �, El 1-1 ❑ El <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL <br /> Forward shall have no obligation io 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 <br /> reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE BIO AERATE 57t7CKPIL OTHER <br /> waste for any reason, If Forward's refusal to accept the waste is based on <br /> weather or other site conditions, Forward shalt notify the Disposer when site ❑ SOIL <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> REMARKS <br /> NON-FRIABLE <br /> ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGEj�lT -. DATE <br /> J ! s ` ❑ ASH <br /> 'i i' �. 6 ❑ OTHER <br /> SCHEDULING 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 /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # C 6 6,7 0 71 <br /> FOS 4C951 INH)6-96 SALES COPY <br />