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WA <br /> �� NON-HAZ�' )OUS WASTE MANIFEST <br /> FOR WASTE TREATMENT AND DISPOSAL FACILITY <br /> /NC. JOB ACCEPTANCE NO. — /2y(-) <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CCI} de_ ❑GLOVES []GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS - ❑TY-VEK ❑OTHER <br /> SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE ZIP <br /> elo <br /> PHONE <br /> 70 7 __3 C y-z <br /> CONTACT PERSON <br /> LL MC 1XII144.D - <br /> a SIGNATURE OF A [ZED AGENT 1,T[1LE DATE <br /> 7/17 L/ <br /> WASTE TYPE RECEIVING FACILITY . <br /> ❑ SLUDGE <br /> • ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> 1 • DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ASH 9999 SOUTH AUSTIN ROAD <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> C �IV V1 (209) 982- 1009 FAX <br /> NAME - . - �: UCK NUMB <br /> NOTE <br /> ADDRESS r� ZZ <br /> • CITY,STATE ZIP `. <br /> �.,...- <br /> • lax- <br /> PHONE END DUMP'; BOTTOM DUMP _r- TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER_ DATA - -` ROCL-OFF(S)._ kLATBEl7 -Y1VAI '; DRUMS' <br /> FORWARD INC. LANDFILL 'B'Q`Y14RQ � <br /> Forward shall have no obligation to accept the waste if weather or other 1 <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPdSAL METHOD:' (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill. Forward shall use ��PO _ AERATE _ OTH� <br /> reasonable efforts to promptly notify Disposer of its inability to accept the ._ . z - ..-. <br /> waste for any reason. If Forward's refusal to accept the waste is based on Q SOIL <br /> weather or other site conditions, Forward shall notify the Disposer when site VJ <br /> • conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑SLUDGE <br /> • REMARKS <br /> • NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT - DATE <br /> I ❑ ASH <br /> ` ` ' ` 1 r' �� ,� ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4:00 P.M. 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 # 35019 <br /> GENERATOR COPY <br />