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�/ R NON HAZARDOUS WASTE MANIFEST <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> IMC. JOB ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAL PROTECT 'E EQUIPMENT - <br /> MALER _1ND115TRIES []GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HA <br /> MAILING ADDRESS CITY-VEK ❑OTHER <br /> CITY,STATE,ZIP,`0 Ashler Avenu_- <br /> SPECIAL HANDLING PROCEDURES: <br /> • LOS Gatos, !.�.ii .g50jC <br /> PHONE ' <br /> CONTACT PERSON <br /> SIGNATURE OF AUTHORIZED AGENT/ TITLE DATE <br /> f l.�l/Lr1 � � 1"aCLO^ ?1/?4JRE <br /> WASTE TYPE <br /> r_1 SLUDGE <br /> ElTREATMENT SOILEl DISPOSAL SOIL E] NON-FRIABLE ASBESTOFORWARD INC. LANDFILL <br /> ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY - (209) 982-4298 PHONE <br /> r,._;re Ave. (209) 982- 1009 FAX <br /> NAMENOTES: _ TRUCK NUMBER - <br /> ADDRESS _ <br /> 9CN�s Ty <br /> . CITY STATE ZIP ' f yt4 06. 3 <br /> HONE END DUMP t BOTTOM DUMP <br /> _/ c _ ,TRANSFER <br /> t3�-�fiaS [ ❑ ❑ <br /> SIGNATURE iZE ENT OR DRIVER. 'DATE ROLL❑-0FF(S). j.FLAT-BED VA. DRUMS <br /> ZAFORWARD INC. LANDFILL CUBIC�Y�ARDS <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 <br /> impairs the safe and effective operation of the Landfill. Forward shall use DISPOSAL METHOD: (TOBECOMPLETEDBY FORWARD) <br /> reasonable efforts to promptly notify Disposer of its inability to accept theISD P `"BIO. -. AERATE SWCKPILE OTHER'. <br /> waste for any mason. 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 am expected t6 change such that Forward will be able to accept <br /> the waste. <br /> REMARKS ❑ SLUDGE <br /> s <br /> ❑ NON-FRABLE <br /> FACILITY TICKET,NUMBER - ASBESTOS <br /> _ ❑ WOOD #` <br /> SIGNATUREOFAUTHORIZE�DAGEN�N DATE <br /> ❑ 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 BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (209) 982-4298 - - <br /> ___.__ MANIFF_ST # /I 1 0n 7 <br />