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WAR® " NON-HA7' �DOUS WASTE MANIFEST
<br /> WASTE f ,NI-MENT AND DISPOSAL FACILITY
<br /> INC. JOB ACCEPTANCE NO: � ' '�f _�, �
<br /> GENE REOUIREDvP,ERSONAL PROTECTIVE EQUIPMENT r _„ r,;
<br /> E.Z..__SEBVE QF CALIF E]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT
<br /> MAILINGADDRESS r ...t g w`„ _:si ,; ❑TY-VEK ❑OTHER
<br /> - P 0 80X,..922021,,,, ,—,.,.,�,... ,, .p.. - -x•- SPECIAL HANDLING PROCEDURES: -
<br /> C17Y,_STATE_ZIP,.,�
<br /> • _ HOUSTON,--TEXAS.-,77292-2021
<br /> �� sa4 a3az
<br /> CONTA�/f RSON
<br /> _...
<br /> 51R ,JIM_.,SHIFLET.,.n
<br /> . SIGN RE AU HORIZED AGENT/'TITLE
<br /> * FLS_. . . I
<br /> ` WASTE TYPE r�+ h ,:;_ :;' ;' RECEIVING FACILITY
<br /> ❑ SLUDGE A
<br /> TREATMENT SOIL - ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL
<br /> - ❑ DISPOSAL SOIL ❑ wOOD 9999 SOUTH AUSTIN ROAD
<br /> ❑ CONSTRUCTION SOIL ❑ ASH
<br /> ❑ OTHER MANTECA, CALIFORNIA 95336
<br /> a
<br /> j
<br /> GENERATING FACIUTY ,,, k',;;. �� ,,, ,, , ::.,., r, (209) 982-4298 PHONE
<br /> 239 S. STOCKTON ST. (209) 982- 1009 FAX
<br /> RIPON, CA
<br /> M,
<br />,
<br /> NOTES TRUCK NUMBER
<br /> NAM ._
<br /> E _ :.,.aa.._ -. _ ✓,.. -
<br /> i P;gHNANILTON_ TRUCKINO ,3 0
<br /> -pALINE AVE. .,;, LOAD #1
<br /> - CITY,-pS..��TA4E.ZIP:U'-= ;,,,:,', _•
<br /> • PHONEODESTO,CA 95358 ��, s,.t, END DUMP,;;; .y BOT DUMP :TRANSFER
<br /> ;,
<br /> ((209) 578-4100
<br /> --
<br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLLFF(S) FLAT-BED VAN DRUMS
<br /> El 1-1 El
<br /> * I
<br /> FORWARD INC. LANDFILL cuBlc YARDS_
<br /> f
<br /> Forward shall have no obligation to accept the waste if weather or other 19 r.y. 1
<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 % '' DISPOSE BIOAERATE STOCKPILE _OTHER
<br /> reasonable efforts to promptly not
<br /> 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
<br /> ' conditions are expected to Change such that Forward will be able to accept
<br /> the waste r ❑ SLUDGE
<br /> r REMARKS NON-FRIABLE
<br /> FACIc rrsr---- e-,'? ..:.y El ASBESTOS -
<br /> LfTY,TICKET,NUMBER_ a_ a ;,
<br /> . ❑ WOOD ---
<br /> I SIG - R OF,Al1T ORIZE DATE
<br /> _ _ ...,.. ❑ ASH
<br /> I�
<br /> OTHER
<br /> 11111111111�L
<br /> SCHEDULING MUST BE MADE PRIOR TO 4:00 P.M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE
<br /> i 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# 14730
<br /> i
<br /> i
<br /> A TRANSPORTER COPY _
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