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IKON-HAZA�US WASTE MANIFEST <br /> (1 . - ,T0R-WAR9*-- <br /> 1 ,'!-CC-R I' O R A T E D WASTE TREATN N AND DISPOSAL FACILITY <br /> JOB ACdEPTANCE NO. . 744911 <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ' 01�z ypi=Oil 5JGLOVES []GOGGLES ❑RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ❑TY-VEK []OTHER <br /> 2160'_k&bdk W-11 <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES: <br /> -- <br /> ' • PHONE <br /> (92`5)V73-9238 <br /> CONTACT PERSON <br /> SIGNATURE OF AUT ORIZED AGENT/TITLE DATE <br /> - <br /> • WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • Q DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> El CONSTRUCTION SOIL ❑ ASH <br /> ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 2502 SArffi BjLanwayay (209) 982- 1009 FAX <br /> NAME TRACTOR LIC. # TRUCK NUMBER <br /> ADDRESS TRAILER LIC_ # !L t <br /> • CITY, STATE, ZIP TRAILER LIC. # <br /> PHONE ;r END DUMP BOTTOM DUMP TRANSFER <br /> 03 74 D ❑ ❑ <br /> SIGNATURE -OFF(S)OF AUTHORIZED AGENT OR DRIVER. DATE ROLL FLAT-BED VAN DRUMS <br /> f � <br /> .1 <br /> i <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 <br /> reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE BIO AERATE STOCKPILE OTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on SOIL <br /> weather or other site conditions,Forward shall notify the Disposer when site '' <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> • REMARKS <br /> w NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TIG.K& NUMBER - <br /> f ❑ WOOD <br /> SIGNATU,RE OF AUT RIZED A dNT. DATE- _. x <br /> �� El ASH <br /> ❑ 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 13E SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> IFC)i <br /> O SCHEDULE CALL (209) 982-4298 SALES COPY MANIFEST # C 667 <br /> 7, <br />