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WARD <br /> NON-HAZARDOUS WASTE MANIFEST ar <br /> WASTE TREATMENT AND DfSPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. { <br /> GENERATOR —^- - REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> _]GLOVES ❑GOGGLES ❑RESPIRATOR []HARD HAT <br /> MAILING ADDRESS ;. ❑TY-VEK ❑OTHER <br /> p.,., �5c �3 . <br /> CITY,STATE;'ZIP. + SPECIAL HANDLING PROCEDURES: <br /> • PHONE <br /> �. � <br /> CONTACT P RSON; <br /> SIGNATURE OF AUTHORIZED AGENT"/TITLE t3AtEE <br /> WASTE TYPE RECEIVING FACILITY,,-.-,,,',, <br /> ❑ SLUDGE <br /> ■ ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL [] WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ■■ ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY. (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> 121 �01-r, Cs <br /> NAME <br /> NOT>=s. j TRUCKE�IUMBER <br /> - <br /> Lo <br /> ADDRESS %1,C� z G ' a c,, 1. <br /> Ick lc� � <br /> . • CITY,STATE,ZIP <br /> /,o n`) <br /> PHONE l END DUW,. BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR-'IVER DATE ROLL-OFFS) FLAT--BED VAN DRUMS <br /> El 11 El <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 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 DISPOSE.':,.BIO AERATE STOCKF`li= OTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on <br /> weather or other site conditions, Forward shall notify the Disposer when site ❑ SOIL <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 eKE�NUMBE <br /> ❑ WOOD <br /> SIGXTURE CSF`A HORI D AGE DATE <br /> J ❑ ASH <br /> (1 ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR O 4: P.M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVA ING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (209)982-4293MANIFEST # 49513 <br /> GENERATOR COPY <br />