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NON-HAZ, . .JOUS WASTE MANIFEST <br /> HE WA RD WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE N0. (,,,, - /-2 Y u= <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> L,+�, L (�j cc/-) []GLOVES ❑GOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS • ❑TY-VEK ❑OTHER <br /> � <br /> STATE,ZIP 1 <br /> CITY. acx <br /> SPECIAL HANDLING PROCEDURES: <br /> �10 U/f,7� (2'4 - <br /> PHONE <br /> • /'v7 %�/ 6 t/7- <br /> CONTACT PERSON _ - <br /> `� LL me_ Z;�)N14 <br /> SIGNATURE OT:AUTHOFAZED AGENT/TITLE DATE <br /> WASTE TYPE` _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • 0.DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> •• ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERA NG FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAME t- �„ ''~ NC' ES 'zs TRUCK NUMBER <br /> k t- t <br /> _ <br /> ADDRESS to — <br /> • CITY,STATE,ZIF'r _ <br /> 0 <br /> �►� ,,.. <br /> �► <br /> PHON4,: - t e END DUMP . BOTTOM DUMP TRANSFER <br /> SIGNATURE OAUTHORIZED-AGENT OR DRIVER DATE .ROLL-0FF(S) FLAT BED VAN DRUMS <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL ` <br /> Forward shall have no obligation to accept the waste if weather or other �, L <br /> conditions impair-the safe and effective disposal of the waste or if the waste DISPOSAL METHOD-- (TO BE COMPLETED BY FORWARD) <br /> impairs the safe_and effective operation of the Landfill. Forward shall use .s DISF'OS BIO JAER�ESTOCKPIILE 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 <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE ' <br /> • REMARKS NON-FRIABLE <br /> • ❑ ASBESTOS <br /> FACUTY TICKET NUMBER <br /> _,_ ❑ WOOD <br /> s - SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> *; �__ `-�- / 1 ❑ 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.CNGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CAC't ;209) 982-4298 MANIFEST * 015061 <br /> GENERATOR COPY <br />