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U _ NON-HAZARDOUS WASTE MANIFEST <br /> ' I N C O R P O R A T E D WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. E : <br /> ' GENERATOR REOUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> 2.fS?PezAourn fDGLOVES ❑GOGGLES []RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ❑TY-VEK [:]OTHER <br /> �1 2191 .z-Y Dmv <br /> CITY, STATE,ZIP SPECIAL SPECIAL HANDLING PROCEDURES <br /> S+Xddr--C k9!206 <br /> - PHONE <br /> CONTACT PERSON <br /> ' SIGNATUPE OFkUTHORIZED AG I14T!TJTCE DATJE <br /> ' F WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATIJENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • Q DISPOSAL SOIL ❑ WOOD <br /> E3 CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 953` <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> ' 9aS MlcEr, =.i4�TcC� (209) 982- 1009 FAX <br /> AME TRACTOR LIC fL-j`S2� TRUCK NUP <br /> ' ' ` <br /> ADDRESS I TRAILER LIC <br /> CITY,STATE,ZIP TRAILER LIC # <br /> 1361Q <br /> PHONE _' END PUMP BOTTOM DUMP TRA(LfS\52�3El <br /> �� �' / `-L l� ❑ <br /> SIGNATURE OFA AUTHORIZED AGENT OR DRIVER DATE ROLI'-bFF(S) FLAT-SED VAN DI <br /> ,� ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YATSI --b <br /> / <br /> Forward shall have no obligation to accept'he waste if.reacher or other t- <br /> conwtions impair the sale and effective disposal of the waste or if the wasle DISPOSALJAETHOD (TO BE COMPLETED BY F <br /> impairs the sale and effective operation of the Landfill Forward sh411 use <br /> reasonable efforts to promptly notify Disposer of as inability 10 accept the / DISPOSE BIO AERATE STOCKPILE <br /> waste for any reason If Forwards refusal to accept the waste is based on, r <br /> weather or other site concMons Forward shall notify the Disposer when sae ❑ 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 /> FACILITY TITET NUMBER ASBESTOS <br /> , <br /> ❑ WOOD <br /> SIGNATU J OF AUJ iORIZEO GI NT, DATE �- <br /> I �r, <br /> ASH <br /> OTHER�-' ,' �+ ❑ 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 /> 'TO SCHEDULE CALL (209) 982-4298 # C 688979 <br /> F01 IC851 4wHJ E P6 GENERATOR COPY MANIFEST <br />