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T UIX VVMkii ,``i NUIN-hALA4�;7JUb VVAbI t MANIrtbI <br /> I N C O R P O R A T E b• WASTE TREE ANT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. 644i1I <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GUNTERT STEEL E]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> 222 E . 4TH ST. <br /> CITY,STATE,ZIP _ - SPECIAL HANDLING PROCEDURES: <br /> RIPON , CA 95366 <br /> PHONE <br /> 209-599-6131 <br /> CONTACT PERSON` <br /> CHRIS GUNTERT <br /> SIGNATUC=OF AUTHORIZED AGENT/TI E DATE <br /> )- <br /> • <br /> WASTL TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • EY DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> • GENERA71NGFACILITY (209) 982-4298 PHONE <br /> (209) 7982- 1009 FAX <br /> NAME - NOTES: TRUCK NUMBER <br /> RICH HAMILTON TRIJC —T'!G qC l6 2--/ 9 7� 6) <br /> ADDRESS V j- 5- 37q <br /> 1336 PAULINE AVE . LOAD k3 <br /> • CITY,STATE,ZIP <br /> MODESTO , C,? 95?53 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-579-4100 Ox ❑ ❑ <br /> SIl NA RE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL <br /> CUBIC �n <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 / DI�SPOS@ r BIO AERATE STOCKPILE OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the .. <br /> waste for any reason. If Forward's refusal to accept the waste is based on , ❑ SOIL <br /> weather or other site conditions,Forward shall notify the Disposer when site <br /> conditions are expected to change such that Forward will be able,to ag� - ❑ SLUDGE <br /> the waste. <br /> • REMARKS NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT / DATE <br /> ❑ ASH <br /> OVER <br /> SCHEDULING <br /> SCHEDULING MUST BE MADE PRIOR TO •OO P.M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON AORNNILeONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (209)982-4298 MANIFEST # 7 Q 7 8 <br /> TRANSPORTER COPY <br />