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�® NON-HAZA OUS WASTE MANIFEST <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. F;�111 - Z Y p <br /> GENERATOR _ .. . REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C �E C wQ�� ❑GLOVES ❑GOGGLES ❑RESPIRATOR CHAR D HAT <br /> MAILING ADDRESS" _ _ . ❑TY-VEK ❑OTHER <br /> -Pb t oA 7 S <br /> CITY,STATE,.Z1F .., SPECIAL HANDLING PROCEDURES: <br /> _ .� �.::.. �. ... � w,� ._ <br /> R i 0 ol-q- _ /t <br /> PHONE <br /> 7 7 37�/. . 4 Y 7Z <br /> CONTACT"_PERSON <br /> l�L /�� Do.t/y C D <br /> SIGNATUR OF AUTHQRIZED AGEYT/TITLE DATE <br /> 10117 9 <br /> WASTE TY RECEIVING FACILrrY <br /> ' ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • FT DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> ' GENERATING:FACILITY.. _:. _�- (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> ' -- NOTES_ TRUCK NUMBER <br /> ' ADDRESS r / <br /> • aTY s~air a ... .. <br /> a w <br /> PHONE �` :'� '°s' END DUMP BOTTOM DUMP _ .., TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF"AUTHOR AGENT OR DRIVER,' DATE ROLL-OFF(S) FLAT-BED _ VAN ^_ DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL cuBlcYARDs <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 DISPOSALMETHOD: (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the landfill. Forward shall use DISPOSE 81O AERATE STOCKPILE 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 SOIL <br /> weather or other site conditions, Forward shall notify the Disposer when site Er <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 /> FACILCFY TICKET NUMBER _:". 1 <br /> ..._.__..-_--. ..._. ❑ WOOD <br /> SIGN,ATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> ❑ 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 # 35025 <br /> GENERATOR COPY <br />