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ARD NON-HAZ DOUS WASTE MANIFEST <br /> f' WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. <br /> GENERATOR r_ REQUIRED PERSONAL.PROTECTIVE EQUIPMENT <br /> Q( U(iE L lti Dom c/ St"A [:]GLOVES []GOGGLES []RESPIRATOR []HARD HAT <br /> MAILING ADDRESS _ ❑TY-VEK ❑OTHER <br /> 7 5 -- SPECIAL HANDLING PROCEDURES: <br /> CITY.STAT—ZIP <br /> I PHONE s <br /> 7U 7 37-Y 6 <br /> CONTACT PERSON. <br /> SIGNATURE OF AUTH(3{iIZED AGENT/Tm.E DATE_ <br /> .. <br /> lei sol` 0 v <br /> WAST1/4Y1,F RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • [DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATINGFACIUTY- _.. _ -_ (209) 982-4298 PHONE <br /> (209) 982-1009 FAX <br /> NAME ,� WOTES : . _ NUMBER <br /> .. ..,'., <br /> DRESS <br /> . <br /> C9 STATE.ZIP { <br /> 14-G, 1-,,olp CA. . QSZZ d <br /> PHONE - k `__END DUMP BOTTOM DUMP TRANSFER -: <br /> 31 loo / T_ -- --� - ❑ _._ __ ... <br /> SIGNATURE OF AU71ZED AGENT OR DRIVEL DATEROLL-OFF(S) FLAT-❑BED A DRUMS - <br /> FORWARD INC. LANDFILL EueC:YARDs: _ ._r. -• :.:. _ <br /> �-Z <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 DISPOSAL METHOD: (TO BE COMPLETED EM,FORWARD) <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 u DISPOSE 8_IO�' AERATE OTHER <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 /> REMARKS <br /> NON-FRIABLE <br /> • _ �-. -: ❑ ASBESTOS <br /> FACILITY TICKET NUMBER - <br /> ❑ WOOD <br /> SIGC4ATURE OF AUTHORIZED AGENT U � kDATE 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 12091 982-4298 MANIFEST # 35035 <br /> GENERATOR COPY <br />