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1 vii vv111\ F f7 NUN-HAZAF(,0;-_QUS WASTE MANIFEST <br /> i - I N C O R P O R A T f s WASTE TR HENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. �Y ` <br /> GENERATORa <br /> ❑ ❑ <br /> REQUIRED PERSONAL PROTECTIVE <br /> EQUIPMENT <br /> EIGOGGLES []RESPIRATOR ❑Gu NTt ni ST s MAILING ADDRESS HARE)HAT <br /> TY-VEK <br /> OTHER <br /> CITY,STATE,ZIP SPECIAL NDLING <br /> PROCEDURES: <br /> • PHONE R I PO m-,' 9 S 3 <br /> CONTACT PERSON ` - S g - G / 3 / <br /> CAR /5 GUNrroe-r <br /> SIGNATUR OF AUTHORIZE AGN / TITLE DATE <br /> WASTE PE RECEIVING FACILITY <br /> El SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑, DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAME n 1 c 9 C NOTES: TRUCKNUMBER <br /> e N /�a, v. �c Tis,^ 1'+e c�<r(r.✓G /& 1(1/ V <br /> ADDRESS ( o� C� <br /> 1336 Phutrr✓� Ate£ , 1V.TS3 ?`; <br /> • CITY,STATE, ZIP <br /> 711out i s � , 9 5— .3 5-9 10141) r � <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> .coq - s760 41 ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> * ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS - <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 DISPOSAL METHOD: (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill. Forward shall use <br /> reasonable efforts to promptly notify Disposer of its inability to accept the � DISPOSE BIO AERATE STOCKPILE OTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on 0' IL I <br /> weather or other site conditions,Forward shall notify the Disposer when site ❑5 <br /> conditions are expected to charge such that Forward will be able to.accept ,'/ <br /> • <br /> the waste. SLUDGE <br /> REMARKS <br /> . ❑ NON-FRIABLE <br /> ASBESTOS <br /> FACILITY TICKET t�7UMBER <br /> / ❑ WOOD <br /> SIGNATUOE OF/AUTHORIZED AGENT 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 MANIFEST # 76552 <br /> GENERATOR COPY <br />