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OR ��� NON-HAZAOUS WASTE MANIFEST <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> L JOB ACCEPTA �s [ I <br /> O. e <br /> iIL <br /> GENERAT,01i ri REQUIRED PERSONAL.PROTECTIVE EQUIPMENT <br /> Q GLOVES []GOGGLES ❑RESPIRATOR HARD HAT <br /> :MA1L[NG ADDRESS r,...;'M. ca'.:.>,.. . .... ' ..','.-�...1`: ❑TY-VEK []OTHER <br /> X <br /> CITY STATE,ZIP '` " SPECIAL HANDLING PROCEDURES: <br /> w <br /> ;CONTACT.PERSOK <br /> SIGNATURE,OF AUTN IZED.AGF-NT./TITLE= ' " DATE•' <br /> WASTE:TYPE '.. .?- RECEIVING <br /> I <br /> ❑ TREATMENT SOIL p NON REABLE ASBESTOS -FORWARD INC. LANDFILL <br /> DISPOSAL SOIL ❑ ASHD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL .❑ ASH' . <br /> E] OTHER MANTECAT CALIFORNIA 95336 <br /> • r .t � <br /> I <br /> FACILITY 209 <br /> GENERATING Fti ( _� <br /> ._. ... ... .._ _.. .. .. .: . .... r.. . � ,. :.:..._:. ...�..�.�.� r.:�.,�.., . ) 982 298 PHONE <br /> (209} 982- 1009 FAX � <br /> NAME .s r - <br /> �'j�,G F �..r/_ s,i', LS J .:?'' 7E i..1.-„t:•t�-,_•:.•n” w ,�-;TOLICK <br /> C <br /> i��. F"0., t•*y�AaWL 4 _t,vCiB L�F71 4 i �•_.- �E_+.r. h 1 1UlJK-NU MBER _ <br /> Y _ <br /> AQDI3ESS r� 4i - --70' <br /> �`•� f1i:In:Yi'rSesi3,'�;tG.'�,n€ ri <br /> I C11Y,STATE,Z!•P �.r��;.��.�.'J��°��,.����.}'�,�'�.>�J! «�"+�!�'Y:x ,�� y;iE�.it:f��::.:t:. <br /> Lr 4,v^7 CSL C-4 C y4,-J c.� <— <br /> pE�HNE � �;rrr: °• �F.A�e�?-'^�'-! r„�7 � � '� �'!��-'Stn ', r^ya �h:. e <br /> END:.DUMP .XiBHT70M DUMP "TRANSFER <br /> SIGNAT E OF AUTHORS �D-AGEIJT R�DRIVER SATE � ; � _ ROLLL OFFS} � � >=LAT BED; i VAN ,.;DRUMS <br /> ❑ ❑ ❑ ❑ I <br /> i <br /> FORWARD INC. LANDFILL cUBiC YARDS', <br /> Forward shall have no obligation to accept the waste if weather or other Ice <br /> conditions impair the sate and effective disposal of�the waste or if the waste <br /> DESPOSAL.ME7HQD::: ::,(TO BE COMPLETED BY FORWARD) <br /> impairs the sate and effective operation of the Landfill. Forward shall use -, 4 : 4. . •� <br /> reasonable.,efforts to promptly notify Disposer of its inability to accept the ,r„ r� DISPOSE • 810 AERATE STOCKPILE OTHER <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.--' OIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER4 q '.;: ASBESTOS <br /> WOOD <br /> SIGN UFiE,qFY1lJTHOI�NZED AGEIVt DATE' <br /> U! 7.../rw... f f El ASH <br /> `-'- ❑ OTHER <br /> i ..HEDULING MUST BE MADE PRIOR TO 4:00 P.M. THE DAY PRIOR TO EXPECTED ARRIVAL ANY UNSC.XEDULED LOADS ARE; <br /> .' 1r�' �_ N�r±n.I - - .. ,C ��l�. -•r,_a:Gt}tom- r' - ..�= �� _.. 14�IT'� - --'1�r -_ _ •! 7m. <br />