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�OR ARD �,_ �, NON-HAZARDOUS WASTE MANIFEST <br /> (A_9;� _ <br /> 1 1V C O R P O R A T D WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. 745711 <br /> ENERATOR REOUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> petok= K]GLOVES ❑GOGGLES []RESPIRATOR OHARD HAT <br />' MAILING ADDRESS - ❑TY-VEK []OTHER <br /> 2191 Njny Drs e <br /> CITY,STATE,ZIP SPECIAL FIANDLING PROCEDURES <br /> 3tocl:MCA 95245 <br /> PHONE <br /> CONTACT PERSON <br /> SIGNATURE OF AUTHORgED GENT/TITLE DATE <br />' WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> ' E7 DISPOSAL SOIL ❑ A <br /> El CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (249) 982-4298 PHONE <br /> 1..a 4':La a21-'s iVCN��ns <br /> 1 --� (209) 982- 1009 FAX <br /> ME- TRACTOR LIC TRUCK NUMBER <br /> Q U T- d---, 9wy'�F./ <br /> ADDRESS TRAILER LIC # �I <br /> • CITY, STATE,ZIP TRAILER LIC # <br /> PHONE .` END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHPRIZED AGENT OR DRIVER 6ATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other ! j <br /> conditions impair The safe and effective disposal of the waste or :f the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward sl all use <br /> reasonable efforts to promptly notify D:sposer 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 cono+tions, 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 Ti, ET NUMBER <br /> •' �'% ❑ WOOD ---- <br /> SIGN RE,4 AU'tH 'RIZ AGENT DATE >- <br /> �� J ❑ ASH <br /> + r <br /> L +/ ❑ OTHER <br /> SCHEDULING MUST BE MADE PRION 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 /> 1SCHEDULEOCALL (209) 982-4298 MANIFEST # C 6 0 8 9 7 4 <br /> 1IG951INH)6 A6 ` GENERATOR COPY , <br />