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WARD <br /> NON-HAZARDOUS WASTE MANIFEST <br /> WASTE TREATMENT AD DISPOSAL FACILITY <br /> INS_ JOB ACCEPTANCE NO. <br /> GENERATOR . ; z , a''� ;< 4F 5-,` .- ,' J�; , r ' REQUIRED PERSONAL PROTECTIVE EQUIPMENTI, <br /> � o f2l [:1l ��3/�05 ry �, GLOVES C-]GOGGLES ❑RESPIRATOR HARD HAT <br /> MAILING ADDRESS � , r �+�, � ❑TY-VEK [JOTHER <br /> CITY,SllTATI�,' I ri ` '#1Y' •,+' ,v ws", „t,.i¢ «s?` '�' 5 SPECIAL HANDLING PROCEDURES <br /> TSL "U!' <br /> - <br /> PHONEV. <br /> tit 2GrA <br /> RSONF AUT I T / TITLE D E <br /> a 71 <br /> WA TE TYPE w ,a <br /> ti1 i= A k eA 'Fi <br /> RECEIVING FACILITYxL Kf�,A� n-��; z� �. �' �' <br /> ❑ SLUDGE <br /> 4 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 <br /> � 1�clur�( t - (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAM <br /> � �0. iT�C� �'�f�"�'�""7 "o r•��Y' ,�NOTES,..r��,.�,;�a�` ��r���s�r �x�'� ,�TRUCK3NUMBEI� '��= <br /> ADDRESS ! yb 3' / /®l �✓J�30�"` „z ���� <br /> CITY,STATE,ZIPG(/�,�`.j <br /> ! PHONE y�/ / Ov^7' END DUMP BOTTOM DUMP ` ' , TRANSFER <br /> b v / rig_ ,� �. res <br /> SIGNATURE'6r,AUTHORIZED AGENT'OR DRIVER DATE'— _, ', ROLLEl <br /> 7M, <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste of weather or other 3 ( t <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD "", O BE COMPLETED BY 011WARD)a <br /> impairs the safe and effective operation of the Landfill Forward shall use , . <br /> promptly Y p y `' ' , _,, DISPOSE r Bio t AERATE STOCKPILE ` ER <br /> si reasonable efforts to romptl notify Disposer of its inability to accept the <br /> waste for any reason If Forwards refusal to accept the waste is based on <br /> t� weather or other site conditions,Forward shall notify the Disposer when site ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste <br /> .t ^«v ❑ SLUDGE <br /> REMARKS - <br /> y3 <br /> ) <br /> a xr yPi <br /> ❑ NOP!-FRIABLE <br /> FACILITY,TICKET NUMBEki , ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE_Oft AUTHORIZE[ 'AGENT �� '17 7N bXTE <br /> ❑ ASH <br /> � 1 <br /> ❑ OTHER <br /> IIJG MUST RE MADE Pnl()r; 10 1 01) F'1%1 TIIF DAY rr1011 it) EXf'r( IFF) AfIrIVAL a ANY UNSCHEDULED LOADS ARE <br /> Sf in lrr r r0 nEr-USAl_ tWOM AI•nn/Al ()W101I IC,I)AII Y f)r-I rvrrtlr,.AM ,1 17- ;( I Irf)t_11 Frl Wrr1I TI IE LANDFILL THE DAY BEFORE <br /> 7(] c;(;Ifr?f)Ui-E CALL (209) 9F32-470f3 5084 <br /> MANIFEST # <br /> Tri/IrJ^,rOfI1FR copy <br />