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NON-HCA17- lUS WASTE MANIFEST <br /> )r WAR ; ." . . WASTE T*ATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. s3 t GSS off ti F ', <br /> GENERATOR _ ; REQUIRED PERSONAL PRO_TEC_TI_VE__E_ QUIPMENT,, ,* <br /> ....�[.awa...mi.a:+f.uS L....0..Li .:..1..11�....::wl... ..-..-.....- .-.. � <br /> E []GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> �E OF CALIF q <br /> MAILI D ,.-.,.�.�,s+�< -�•�.c;.;.`..p�s.. ._ .._, t ".'' ❑TY-VEK ❑OTHER <br /> CITY gta4� ��( •922021 , : r Y .•« .;� SPECIAL HANDLING PROCEDURES: <br /> • lEiOUSTON, , TEXAS 77292 2021 , <br /> PHON .._....�::;.3..�.......—.K.-.-�f t ,_...-,; Y y .s..,e..: , . ,r•�.k�� <br /> CONTRCT $ON4312 r s - s e'r' <br /> ...." k AUTR� 2ED AGENT,/TITLE , ; DATE <br /> 93 1 <br /> WASTE TYPE A RECEIVING FACILITY '. : <br /> z,.. ,. <br /> ti r_ <br /> ❑ SLUDGE <br /> TREATMENT SOIL - ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • DISPOSAL SOIL ❑ WooD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL 171 ASH' <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> e <br /> GENERATING FACILITY .' (209) 982-4298 PHONE <br /> 239 S. STOCKTQN ST. (209) 982- 1009 FAX <br /> RIPON, CA <br /> f <br /> NAME NOTES_ .th•,_,,z.,, �. ..•<TRUC_K NUMBER <br /> RICH HAMILTON TRUCKING <br /> ADDRESS,_ -. <br /> 1336 PAULINE AVE . LOAD N2 <br /> CITY,STATE ZIP.,.::•.-... ,,.- <br /> MODESTO,CA . ,95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> � .. .... <br /> SIGN A UR OF AU THOR�ZED'AGENT OR_DRIVER. DATE ROLL4FF(S)'' F[ T B@D & VAN DRUMS <br /> �'. 'El El <br /> El <br /> FORWARD NC. LANDFILL <br /> Forward shall have no obligation to acceptl the waste if weather or other f <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL PtETHOD_, .{TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill. Forward shall use ":. <br /> reasonable efforts to promptly notify Disposerkof its inability to accept the �.. atl DISPOSE 610, , AERATE STOCKPILE '.OTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on O L <br /> weather or other site conditions,Forward shall°notify the Disposer when site U-S <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS y 1{n�,C �.. �• <br /> y 3 s e v,rY •w "- NON-FRIABLE <br /> ,�, r^• fa.. ,1,,;. ❑ASBESTOS <br /> FACILITY TICKET NUMBER y <br /> ,. ❑ WOOD <br /> N <br /> SIGNATURE 0 „AUTHORIZEDAGEN DATE , :., <br /> ❑ ASH <br /> L�. /� / ❑ OTHER <br /> LAE <br /> n 12 <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 I`- MANIFEST # 14731 <br />