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WASTE TREATMENTAND DISPOSAL FACILITY <br /> INC. r' JOB AWEPTANCE N0. a.., <br /> GENERATOR. REQUIEiE6:PERSONALPiiQiECTl�TE,EQ411_ x_ <br /> M 0 N I E R , INC . [:]GLOVES []GOGGLES ❑RESPIRATOR - ❑HARD HAT <br /> MAILING ADDRESS _ ❑TY-VEK []OTHER S <br /> 9508 S . HARLAN RD . <br /> CITY„STATE;'ZIP SPECIAL HANDLING PROCEDURES: <br /> : FRENCH CAMP , CA 95221 r <br /> 9280 LH <br /> PHONE <br /> 209-982-1473 _ LLQ <br /> GONTAGTPERSON 3:0GP 6 <br /> _ 14-'y5 <br /> NORMAN KLINGMAN 65760 LA To <br /> SIGNATURE OF,AUTHORIZED AGENT F TITLE DATE <br /> • WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL,.- <br /> • ❑ DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> F1 CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ OTHER sr.CC{I ILE MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAME NOTES: TRUCK NUMBER <br /> RICA HVITELT011 TRUCXTNO, <br /> ADDRESS <br /> 1333 ?AULINE AN;E. /V n <br /> . CITY,STATE, ZIP <br /> % o^=s-D CA 95?53 <br /> • PHONE ENQ QUMP BOTTOM DUMP TRANSFER <br /> 2r,-. ' Q ❑ ❑ <br /> 5 , ;3-4 00 <br /> SIGNATUR AUTTyORLED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMy4 <br /> < ❑ ❑ ❑ ❑ <br /> :�• � of <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 DISPOSE BIO_ AERATE ISTOCKPILE 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 <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 accep <br /> the waste. ❑ SLUDGE <br /> ` REMARKS <br /> i ❑ ASBESTOS <br /> FACILITY TICKET�NUMBER) __ <br /> /� ❑ WOOD <br /> A <br /> SIGNATUF(E UTHORI D GENT' DATE <br /> ASH: <br /> n <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4:00'RM. 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 # C 5483 <br /> GENERATORCOPY <br />