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WARD NON-HAZARDOUS WASTE MANIFEST <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> VAN DEN SERGH FOODS,COMPANY CLOVES [-]GOGGLES [-]RESPIRATOR COBARD HAT <br /> MAILING ADDRESS []TY-VEK [:]OTHER <br /> 1.100 W ATE RLOO ROAD <br /> CITY, STATE, Z1P SPECIAL HANDLING PROCEDURES <br /> STOCKTON.C kLIFORNIA 95208 <br /> PHONE <br /> ' r?04).k�cr95R0 <br /> CONTACT PERSON <br /> RANK YONESHII;;E <br /> SiGDf7lT E OF All ORIZED AGENT/ TITLE DAT <br /> WASTE TYPE RECEIVING FACILITY <br />' ❑ <br /> ❑ TREATMENT SOIL ❑ SLUDGEON-FRIABLEASBESTOS FORWARD INC LANDFILL <br /> • p DISPOSAL SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ,.400 WATERLOO ROAD, STOCKTON,C kLIFORNIA (209) 982- 1009 FAX <br /> NAME NOTES TRUCK NUMBER <br /> `.AS-kLLERO TRUCKING <br />' ADDRESS <br /> 2530 BERRYESSA ROAD STE 52" <br /> . CITY, STATE, ZIP <br /> • <br /> SAN; JOSE CA 95132 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (408) -29-0190 ❑ ❑ Q----- <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 1 <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other l d r <br /> conditions impair the sate 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 STOCKPILE OTHER <br /> waste for any reason It Forwards 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 TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <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 C E 9 0 3 6RE <br />' TO SCHEDULE CALL(209) 982-4298 <br /> GENERATOR COPY MANIFEST <br />