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NON -HAZE, ZOUS WASTE MANIFEST <br />,IRINE2 <br />WASTE TREATMENT AND DISPOSAL FACILITY <br />INC. JOB ACCEPTANCE NO. - <br />L <br />GENERATOR <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />c Ld u l�e C <br />❑ GLOVES ❑ GOGGLES ❑ RESPIRATOR ❑ HARD HAT <br />MAILING ADDRESS <br />❑ TY-VEK ❑ OTHER <br />�J /36,X S �� <br />SPECIAL HANDLING PROCEDURES: <br />CITY, STATE:. ZI� - - <br />• <br />its v (J/'Sr <br />- <br />PHONE <br />77073/ ja 1,17Z <br />CONTACT PERSON <br />SIGNATURE CFAUTHORYEZD AGENT /TITLE DATE <br />WASTE -TYPE i j <br />- <br />RECEIVING. FACILITY <br />❑ TREATMENT SOIL <br />❑ SLUDGE <br />❑ NON -FRIABLE ASBESTOS <br />FORWARD INC. LANDFILL <br />• <br />DISPOSAL SOIL <br />❑ WOOD <br />9999 SOUTH AUSTIN ROAD <br />❑ CONSTRUCTION SOIL <br />❑ ASH <br />❑ OTHER <br />MANTECA, CALIFORNIA 95336 <br />(209) 982-4298 PHONE <br />'GENERATING FACILITY -.: - �.. <br />�;✓���0 <br />(209) 982-1009 FAX <br />NAME A Zjlwh�l� �� .. <br />_ NOTCS� - _ TRUCK NUMBER, <br />/ �% - <br />5.• <br />ADDRESS`_' U ,mss <br />• CITY, STAN ZIP �} Gh 1 «•1,y�. �t <br />PHONE <br />END DUMP- BOTTOM DUMP _ TRANSFER <br />---DRUMS <br />SIGNATURE OF AU ORIZE OR DRIVER DATE <br />ROLL-0FF(S) FGNT BED VAN, <br />FORWARD INC. LANDFILL <br />CUBIC. YARDS.. <br />Forward shall have no obligation to accept the waste if weather or other <br />f C' ;-- <br />DISPO METHOD: (TO BE COMPLETED <br />BY FORWARD) <br />conditions impair the safe and effective disposal of the waste or if the waste <br />conditions <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 <br />DISPOSE BIO AERATEISTOC <br />OTHER <br />waste for any reason. If Forward's refusal to accept the waste is based on <br />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 accept <br />the waste. <br />❑ SLUDGE <br />REMARKS <br />•NON <br />-FRIABLE <br />❑ <br />ASBESTOS <br />FACILITY TICKET NUMBER <br />❑ WOOD <br />- SIGNATURE OF AUTHORIZED AGENT DATE <br />❑ ASH <br />❑OTHER <br />EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE <br />BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE - <br />SCHEDULING MUST 3E MADE ?RiCR TO 4:00 P.M. THE DAY PRIOR TO <br />SUBJECT TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST <br />TO SCNEDULZ CALL '209) 982--L298 <br />'^ r" ' o 0 <br />MANIFEST* <br />GENERATOR COPY <br />