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U%Www"RD <br />/NC. Mpg ACCEPTANCE N0. <br />NON-HAZ. DOUS WASTE MANIFEST <br />WASTE TREATMENT AND DISPOSAL FACILITY <br />C r1 <br />GENERATOR <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />0-4v0& C fN ou f? U Sf� j <br />E]GLOVES [—]GOGGLES ❑RESPIRATOR E]HARD HAT <br />MAILING ADDRESS <br />❑ TY-VEK ❑ OTHER <br />G U 7y <br />SPECIAL HANDLING PROCEDURES: <br />CITY STATE. ZIP <br />• <br />R/U v/ST-,�J <br />- <br />PHONE <br />—7 C'7 S/ <br />CONTACT PERSON <br />5/,C C. �17C /�GN�LJ <br />SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br />• <br />WASTEJYPFt" <br />_ <br />RECEIVING FACILITY <br />❑ SLUDGE <br />FORWARD INC. LANDFILL <br />❑ TREATMENT SOIL <br />❑ NON -FRIABLE ASBESTOS <br />• <br />® DISPOSAL SOIL <br />❑ WOOD <br />9999 SOUTH AUSTIN ROAD <br />❑ CONSTRUCTION SOIL <br />❑ ASH <br />- <br />❑ OTHER <br />MANTECA, CALIFORNIA 95336 <br />(209) 982-4298 PHONE <br />GENERATING FACILITY y _ - _... _ _._... _ .: <br />(209) 982-1009 FAX <br />NAME:.. NOTES ;_ : - ;, TRUCK NUMBER <br />ADDRESS r <br />• <br />CITY STATE, ZIP M....... ,. <br />PHOAIE END DUMP BOTTOM DUMP TRANSFER <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATEROLL-OFF(S) FLAT-BED VAN. DRUMS <br />. _ <br />❑ ❑ ❑ ❑ <br />FORWARD INC. LANDFILL cuBlc YARDS. <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 M O : (TO BE COMPLETED BY 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 _ _, _ DISFOS _ BIO AERATE IST Q(MLE OTHER <br />waste for any reason. If Forward's refusal to accept the waste is based on <br />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 />AEMARKS '"" <br />_ _ _ - ❑ NON -FRIABLE <br />ASBESTOS <br />FACILfT,Y-.TICKET NUMBER <br />❑ WOOD <br />- <br />SIGNATURE OF AUTHORIZED AGENT DATE <br />. <br />❑ ASH <br />Cj / ❑OTHER <br />MUST BE MADE PRIOR TO 4:00 P.M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br />SCHEDULING <br />SUBJECT <br />TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />TO <br />SCHEDULE CALL (209) 982-4298 MANIFEST * 3 50 0 7 a <br />GENERATOR COPY <br />