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44;!n/ ORWAR .1 0.- • NON-HAZARDOUS WASTE MANIFEST <br /> ! ,N C O R P O R A TED y "` WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. 745711`+_� `'•3� �_ <br /> GENERATOR } REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Pe'a leum _ �GLOVES ❑GOGGLES [:]RESPIRATOR 59 HARD HAT <br />' MAILING ADDRESS _ ❑TY-VEK ❑OTHER <br /> 2191 ?:Ery D:xve <br /> CITY, STATE,ZIP SPECIAL HANDLING PROCEDURES <br /> Sto=vmC 4 95206 <br />' - PHONE <br /> CONTACT PERSON <br />' SIGNATURES F AUTHORIZED AGENT//TITLED <br /> AT <br />' WASTE TYPE ( RECEIVING FACILITY <br /> ❑ TREATMENT SOIL ❑ S❑ NOf�N-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> ` ❑ DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br />' <br /> El STOCK PILE ❑ OTHER <br /> • MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> ME <br /> 1 T^r TRACTOR LICE, ' _ �/ / TRUCK NUMBER <br /> ADDRESS b / / r-1 VI�� Q� 1 t. J C�i ..r <br /> TRAILER LIC � f / � n 7 � <br /> P crflii� a e 19 / /uV I l <br /> • • CITY,STATE, ZIP TRAILER LIC # <br /> EN,,-m :A 93 111 <br /> �L✓ l2 ..r► fir. <br /> PHONE <br /> _ f]1 �J ENq DUMP BOTTOM DUMP TRANSFER <br /> ItJi.=.�ij 3_0.311 td� .moi f - 2f /_l^f �❑ El ❑ <br /> SIGN,TUR_E OF AUTHOR[ ED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> IJ ! ❑ ❑ ❑ ❑ <br /> �1 <br /> FORWARD INC. LANDFILL CUBIC YARDS ' <br /> � <br /> Forward shall have no obirpatron to accept , *waste if weather or other / '-6 <br /> the ``� <br /> r <br /> conditions impar the safe and effective disposal of the waste or if the waste <br /> DISPOSAL METHOD {TO BE COMPLETED BY FORWARD <br /> impairs the safe and effective operation of the Landfill Forward shalt use <br /> reasonable efforts to promptly notify Disposer of its inability to accept the �i�� DISPOSE 610 AERATE STOCKPILE OTHER <br /> vraste for any reason If Forwards refusal to accept the waste is based on / <br /> weather or other site conditions Forward shall notify the Disposer when srtef O SOIL <br /> ' <br /> conditions are expected to change such that Fos.ard will be able to accept <br /> the waste <br /> � REMARKS (I SLUDGE <br /> E3 NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> - „ - f -- ❑ <br /> SIGNATU4 OF AUTHORIZE AGENT DATE WOOD' <br /> ❑ ASH <br /> 111� ���_ t S ❑ 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 /> Erp SCHEDULE CALL (209)982-4298 p p <br /> 01(C951 INK)6 96 �'GENERATOR COPY MANIFEST # C 6 8 0 9 7 7 <br />