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AM <br />NON-HAZ, )OUS WASTE MANIFEST <br />FWARD21M <br />WASTE TREATMENT AND DISPOSAL FACILITY <br />INC JOB ACCEPTANCE NO. Iit- - o <br />GENERATOR/ L <br />— C� <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />GLOVES ❑ GOGGLES ❑ RESPIRATOR ❑ HARD HAT <br />w CDC ,���T <br />❑ <br />MAILING ADDRESS <br />❑ TY-VEK ❑ OTHER <br />.% /ACX -0 <br />SPECIAL HANDLING PROCEDURES: <br />STATE; ZIP - <br />_CITY, <br />• /� ti lam'/�`%� C�/� <br />- PHONE <br />-- - <br />' '7o Z <br />CONTACT PERSON <br />& ­ <br />SIGNATUREOF AU3 iORIZED AGENT/ DATE <br />10h 7 <br />WASTEVPE <br />_ <br />RECEIVING FACILITY <br />' <br />❑ SLUDGE <br />FORWARD INC. LANDFILL <br />❑ TREATMENT SOIL <br />❑ NON-FRIABLE ASBESTOS <br />F1 DISPOSAL SOIL <br />❑ WOOD <br />9999 SOUTH AUSTIN ROAD <br />❑ CONSTRUCTION SOIL <br />❑ ASH <br />❑ OTHER <br />MANTECA, CALIFORNIA 95336 <br />(209) 982-4298 PHONE <br />GENERAPINGFACILITY _ <br />(209) 982-1009 FAX <br />i_ 6­V;i. .�.1� .r - : -. --�i:. -: �'.NOT� ' TRUCK NUMBER <br />NAME �y r_ _... ►.. . x��. .. -.ti.._ - <br />ADDRESS sf7 fir,•-�t�ros.'�, L,/�. - / ..- <br />V.V\ <br />• CITY, STATE; ZIP <br />PHONE-:. <br />END DUMP-.BOTTOM DUMP ,;;TRANSFER <br />❑ ❑ ❑ <br />SIGNATURE OF AUTHORIZED AGENTOR DRYER DATE <br />ROLL-OFF(S) : _; --EIAT BED <br />FORWARD INC. LANDFILL <br />CUBIC-YARDS,_,._.:<s,v_:==,:..,_;__;_: _ <br />if <br />/ <br />Forward shall have no obligation to accept the waste weather or other <br />conditions impair the safe and effective disposal of the waste or if the waste <br />DI POSAL METHOD: (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 <br />_ - DISPOSE - ., 'AERATE -- ��= <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 notifythe Disposer when site <br />' conditions are expected to change such that Forward will be able to accept <br />the waste. <br />❑ SLUDGE <br />REMARKS <br />❑ NQN-FRIABLE <br />ASBESTOS <br />FACILITY TICKET NUMBER <br />❑ WOOD <br />- SIGNATURE OF AUTHORIZED AGENT DATE <br />" <br />❑ ASH <br />1 / / <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 SCHIiDULE CALL {209) 982-4298 <br />MANIFEST # 35075 <br />GENERATOR COPY <br />