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WARD NON-HAZ_ JOUS WASTE MANIFEST <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. bVl - z <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> LCL-►i�EC �,)ovo A -554 []GLOVES ❑GOGGLES ❑RESPIRATOR (]HARD HAT <br /> MAILING ADDRESS ❑TY-VEK []OTHER <br /> PC 3&;T - 7.5-Y - _- .. _. SPECIAL HANDLING PROCEDURES: <br /> CITY,STAN ZIP .. :.. . <br /> • Rica uzsr 1 C,4 <br /> PHONE <br /> 707 37y <br /> CONTACT PERSON z <br /> c 171) <br /> SIGNATURE OF AUT RIZFD AGENT l TITLE DATE ` <br /> WASTE TY RECEIVING FACILITY <br /> ❑ SLUDGE <br /> • ❑ TREATMENT SOIL E] NON-FRIABLEASBESTOS FORWARD INC. LANDFILL <br /> • DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY: _, _ (209) 982-4298 PHONE <br /> C� (209) 982-1009 FAX <br /> y 'NATES, -TRUCK NUMBER <br /> NAME �. <br /> ADDRESS <br /> • CITY,.STATE,ZIP <br /> PHONE _ .- a- END DUMP' BOTTOM DUMP TRANS <br /> _.. r__ _.- ._ ❑ ❑ <br /> SIGNATURE OFAUTH IZED AGENT.OR DRIVER DATE' ` ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL cuBr,YARDS <br /> Forward shall have no obligation to accept the waste if weather or other /J <br /> conditions impair the safe and effective disposal of the waste or if the waste <br /> impairs the safe and effective operation of the Landfill. Forward shall use DISPOSAL M OD: (TOB COMPLETED BY FORWARD} <br /> reasonable efforts to promptly notify Disposer of its inability to accept the __ DISPOSE BIO_ AERATE IMOOLEJOTHER <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 <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> • <br /> REMARKS `. - __ <br /> • ,- NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT - DATE <br /> ❑ ASH <br /> — ,� I ,`" 7 ❑ 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 # 35032 <br /> GENERATOR COPY <br />