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F . WARD <br />/NC. JOB ACCEPTANCE N0. <br />NON-HAZi-,, .JOUS WASTE MANIFEST <br />WASTE TREATMENT AND DISPOSAL FACILITY <br />cAlwl - izyo <br />GENERATOR <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />C (_- vi� L C✓� CLU Iry J <br />❑ GLOVES []GOGGLES ❑RESPIRATOR E]HARD HAT <br />MAILING ADDRESS <br />❑ TY-VEK ❑ OTHER <br />!'J 3CI 7 5� <br />CITY, STATE. ZIP <br />SPECIAL HANDLING PROCEDURES: <br />- PHONE <br />.37Y- <br />CONTACTPERSON <br />SIGNATUREZSF AUTHC)RIZED AGE➢IT/ TITLE DATE <br />WASTE TYPE:'/ . ` ._. <br />RECEIVING. FACILITY <br />❑ SLUDGE <br />❑ TREATMENT SOIL ❑ NON -FRIABLE ASBESTOS <br />FORWARD INC. LANDFILL <br />• DISPOSAL SOIL ❑ WOOD <br />9999 SOUTH AUSTIN ROAD <br />O'CONSTRUCTION SOIL ❑ ASH <br />• ❑ OTHER <br />MANTECA, CALIFORNIA 95336 <br />(209) 982-4298 PHONE <br />GENERATING.FACILITY <br />(209) 982-1009 FAX <br />NAME ..._ ' �fiCC�N �` :-- -. :.:.5� <br />_: TRUCK NUMBER <br />_ <br />-�`. <br />._ <br />ADDRESS <br />- <br />IF <br />• CITY, STATI ZIP- <br />_ <br />PHONE- <br />PHONE <br />:: END DUMP BOTTOM DUMP TRANSFER M <br />...._.� <br />SIGNATURE O AUTHO ZED AGENT OR DRIVER DATE <br />ROLL-OFF(S) FLAT-BED ` VAN DRUMS <br />❑ ❑ Cl ❑ <br />7�C"NJ ajkj <br />FORWARD INC. LANDFILL <br />CUBIC_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 <br />DISPOSAL M <br />D: (TO BE COMPLETED <br />BY <br />FORWARD) <br />impairs the safe and effective operation of the Landfill. Forward shall used <br />reasonable efforts to promptly notify Disposer of its inability to accept the <br />__ �. _ <br />_ BIO ��� <br />OTHER <br />waste for any reason. If Forward's refusal to accept the waste is based on <br />waste <br />weather or other site conditions. Forward shall notify the Disposer when site <br />[SOIL <br />/ <br />' conditions are expected to change such that Forward will be able to accept <br />the waste. <br />❑ SLUDGE <br />REMARKS _ <br />NON -FRIABLE <br />❑ <br />ASBESTOS <br />FACILITY TICKET NUMBER <br />❑ WOOD <br />SIGf ATUR1E OF AUTHORIZED AGENT DATE <br />1 <br />1 `7 <br />❑ ASH <br />*/ �, ^ . -� <br />❑ OTHER <br />TO EXPECTED ARRIVAL s ANY UNSC1-IEDULED LOADS ARE <br />SCHEDULING MUST BE MADE PRIOR TO 4:00 P.M. THE DAY PRIOR <br />SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST <br />BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />TO SCHEDULE CALL (209) 982-4298 <br />o <br />MANIFEST # 3 7 rJ <br />GENERATOR COPY <br />%5((�� U <br />