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- A�w��D NON-HAR ZDOWASTE MANIFEST <br /> �+ WASTE TREATMENTT AND DISPOSAL FACILITY <br /> �N�• JOB ACCEPTANCE NO. <br /> GENERATOR REQUIREDPERSONAL PROTECTIVE.EQUIPMENT <br /> A� t�'•+��,I/�� ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAI]�GA,DDRESS ,. ❑TY-VEK - ]OTHER <br /> CITY;STA�E�ZIPIA SPECIAL HANDLING PROCEDURES: <br /> k" ( ICA ) <br /> P ONE <br /> V-7 En <br /> NT N <br /> T PERSON ••:. ,, .�J11 <br /> �lk}� <br /> SI A RE OF AUTHORIZED AGENT / TITLE DATE` ' <br /> lb ' <br /> WASTE E RECEIVING FACILITY <br /> ❑ SLUDGE <br /> TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> CONSTRUCTION SOIL ❑ ASH <br /> 00 THEIR MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE _ <br /> 1� 11Sls Q0y"P 61,E (209) 982- 1009 FAX <br /> NAM '. `.. M`.n N, ,�,� ".�', TRUCK NUMBER <br /> ADDRESS X 7t'k 1 <br /> . CITY,_ ATE, ZIP ! <br /> 84 <br /> y C—)CC <br /> PHO fG�t�CLO�Ir EN UMP BOTTOM DUMP TRANSFER <br /> 157-7 9W - <br /> SIGNATUREJJF AUTHORIZED,AGENT OR DRIVER . DATE +' ,ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> b <br /> ❑ ❑ Il <br /> FORWMRD fNC."LANDFILL <br /> Forward$hail have no obligation to accept the.,;y(,aste if weather or other �� <br /> conditiontApair the safe and effective disposal of t}?ft.waste or if the waste DISPOSAL M HOD: (TO BE COMPLETED BY FORWARD) <br /> impairg';the safe and effective operation of the Lan, 1. Forward shall use _ <br /> Doable efforts to promptly notify Disposer of ds•° bilit to accept the „ , ,;- : DISPOSE "-BIO AERATE STOCKPILE OTHER, <br /> 2$4. P Y Y P , Y .ski .. - - <br /> ,,Waste for any reason. If Forward's refusal to,ac waste is basedon OIL <br /> weather or other site conditions, Forward h e- 'sposer when site <br /> ' conditions are expected to cARpgg, and wi _e able to accept <br /> the waste. *,?F ❑ SLUDGE <br /> • REMARKS '. <br /> ❑ N0N-FRIABLE <br /> ASBESTOS <br /> S <br /> FACILITY ICKER s" <br /> WOOD <br /> SIG . ED .: E a � `�.'�. ❑ <br /> R72/ A ❑ ASH <br /> * y'" w ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4.00 P.M.THE AY PRIOR TO EXPECTED''ARRIVAL • ANY UNSCHEDULED-LOADS.:ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DEILI VERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (209)982-4298 - MANIFEST # 49513. <br /> ,TRANSPORTER COPY S_ ,. <br />