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z +�- UIX YVAALJ NON-HAZARDOUS WASTE MANIFEST <br /> �.►o INCORPORATED 4 <br /> - WASTE TREATMENT AND DISPOSAL FACILITY <br /> JCB ACCEPTANCE N0, 7457 2"t�=�=�i;�-: �-- <br /> GENERATOR <br /> Nom,peVOL-t= REOUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> MAILING ADDRESS GLOVES ❑GOGGLES ❑RESPIRATOR ®HARD HAT <br /> 2191 Nmy Drive ❑TY-VEK ❑OTHER <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES <br /> • Stm1=C.k 9520 <br /> PHONE <br /> ' CONTACT PERSON <br /> SIGNATUeE pF AUTHORIZED AGENT J TITLE DATE <br /> l�li�f <br /> (�% <br /> WASTE TYPE <br /> RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> El DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> El STOCK PILE E:1 OTHER <br /> ' MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY <br /> 93b <br /> 1. <br /> 93 a;y (209) 982-4298 PHONE <br /> ' _1LCa (209) 982- 1009 FAX <br /> 1 <br /> NAME <br /> ' 1-,-''L-0 Thai tr4r, TRACTOR LIC � STRUCK NUMBER <br /> DDRESS Cgo,i/.i iv ,> <br /> rt'►3t Box 5,S TRAILER Ll&,* => <br /> • CITY,STATE, ZIP' <br /> TRAILER Ll � � �/ �7• }nC �,�#: 6' <br /> PHONE <br /> (925)634-0374 END DUMP BOTTOM DUMP TRZUMS <br /> FER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE , ❑ <br /> 6 I �� ROLL-OFFS) FLAT-BED VAN <br /> El <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no ebhgat'on to accept .he waste d weather or other <br /> Conditions impair the safe and effeone d1sposal of the waste or if the waste <br /> impairs the safe a 10 nd effective operation of the Landfill Forward shalt i,se DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> waste nfort anypeason Promptly <br /> Forx d sof notify <br /> Disposer <br /> o accept the waste is based 10 accept the <br /> / <br /> weather or other site condit+ons,Forward shall notify the Disposer when site DISPOSE $!O AERATE STOCKPILE OTHER <br /> cone tons are expected to change such that Forward will be able to accept IL <br /> the waste <br /> REMARKS ❑ SLUDGE <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER - ASBESTOS <br /> SIGNATURE OF A ORIZED AGENT ATE ❑ WOOD <br /> , <br /> ❑ ASH <br /> �] OTHER <br /> REDUCING MUST BE MADE PRIOR TO 4 00 P M. THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> — <br /> T TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WI <br /> TO SCHEDULE CALL (209)982-4298 TIFH THE LANDFILL THE DAY BEFORE. <br /> ttCF5tINH)6 P6 <br /> GENERATOR COPY MANIFEST& C 688981 <br />