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I <br /> NON—HAZARDOUS WASTE MANIFEST <br /> FWWARD WASTE. TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCO-11 TANCE MO. 93 -- 544 <br /> ENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ADIYIMbe�§/Wlly Hiversick, (:crlebt, (.ornpally ❑GLOVES ❑GOGGLES ❑RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER ' <br /> P.O. Rox 4904 <br /> ' CITY, STATE, ZIP SPECIAL HANDLING PROCEDURES <br /> - bi-arlprui Bar, (,A 1)1765 r.do <br /> PHONE <br /> ri CONTACT PERSON <br /> ' .JP711r) €,U11137a <br /> SIGNI" F AUT AGENT / TITLE DATE <br /> *�, c'c�rItr_tcI or <br /> 1612 <br /> 3 <br /> i) WAS E TYPE RECEIVING FACILITY <br /> _ I <br /> SLUDGE <br /> i <br /> ❑ TREATMENT SOIL ❑ NON FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD I <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE 1 <br /> I0:"-) ;icic� t,�rr,E tlt CotJ+:�n� (209) 982- 1009 FAX s <br /> `,tr)rl <br /> AME NOTES _TRUCK NUMBER <br /> ADDRESS Jim 1 horpc 0,.1,L tc. <br /> P.U. Box 3W h <br /> CITY, STATE, ZIP <br /> Lodi, CA, r)�2fll-035( <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ("OIC)3C)-'—G 17') 0 El <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN �DRUMS <br /> a. <br /> a `` ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS 4 , <br /> Forward shall have no obligation to accept the waste if weather or other1P, <br /> �1 conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE.COMPLETED BY FORWARD)- <br /> rmpairs the safe and effective operation of the Landfill Forward shall use <br /> tr reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE BIO _ AERATE STOCKPILE OTHER <br /> waste for any reason if Forwards refusal to accept the waste is based on <br /> tr weather or other site conditions Forward shall notify the Disposer when site -1 SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> = the waste ❑ SLUDGE <br /> It REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> � y ❑ ASH <br /> rE] OTHE""" <br /> ' Its I+III IIIc, rllr^.I rtr- ;%n/ltsr i'rla,R ft, T fart r - 10Ir I)AY prit)tt IO r—,rI r II I1 in"111VAL . ANY Ut'JiCIICDULED LOADS ARC <br /> r I,r #r-( 1 P) s'r f l tnM I I1'( ll AF)rtIV/\I E fr 1 Iwr 111[ '; rAU1.F f tr t 1!r 1),It f f) SNI I I I I I IF U1hfl)FILL I I IF r)AY FiFFOriC <br /> t+, '', I If tart r t t\I I (90o) 9177 a20ri <br /> MANIFEST # 7876 <br /> f rtn,+,f "ItI 111 f,f IF— <br /> F <br />