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"TQRWARD s NON—HAZARDOUS WASTE MANIFEST <br /> v►• INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. 883300,, <br /> EIVERATOR�a" _„n' L,•�:_-_��._ -1 REQUIRED PERSONAL PROTECTIVE EQUIPMENT ' <br /> C1 PeElryvl MGLOVES ❑GOGGLES [D RESPIRATOR ©HARD HAT <br /> MAILING AD'DRESB Y `x "�-�«�y�r' Ar •- - _ ter. ❑ <br /> TY-VEK ❑OTHER <br /> CI7Y 4E AT>"ZlP;�s - {rt`"' `"` - SPECIAL HANDLING PROCEDURES <br /> ZL <br /> (209)943-2012 <br /> C.4NTACT PERSON'S <br /> I�r'ie~Y <br /> 9IGIVATURE OF AUTHORIZED AGI=NT J TITLE DATE - <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • {] DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ED STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 2191 "fiv-y'DrfvQ 111"OCKT1 2 (209) 982- 1009 FAX <br /> AME U -f `� Ti_tA C k i O� / TRACTOR LIC # q q TRUCK NUMBER <br /> ADDRESS �,3 t, C C._' J. TRAILER LIC # T ,t1 13 <br /> • CITY,STATE, ZIP& K (� 'T ,� 1 933 4 TRAILER UC # <br /> PHONE ��r�!-� e-k 11� l ENDIDUMP BOTTOM DUMP TRANSFER <br /> SlGNA7URE AUT!-IORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> * f �f , -� ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shat€have no obligation to accept the waste if weather or other <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (70 BE COMPLETED 8Y FORWARD <br /> impairs the sate and effective operation of the Landfill Forward shall use ) <br /> reasonable efforts to promptly notify Disposer of its inabhty to accept the IDISPOSE BIO AERATE STOCKPILE OTHER <br /> waste 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 site ❑SOIL` <br /> conditions are expected to change such that Forward will be able to accept <br /> ` the waste ❑ SLUDGE <br /> REMARKS r <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> f/ ❑ WOOD <br /> NATURFrOF AU�iOR1ZED AGE)I`f DATE <br /> �y �i�l / i 7 ❑ ASH <br /> i It <br /> 7 C ti i�f y ��, !� <br /> _ ❑ OTHER - <br /> ITOSCHEDULE CALL (209) 982-4298 <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 /> Foy(COSI INH)6 96 — — SALES COPY MANIFEST # C <br /> 72_004 <br /> '7 2 n�} 4 {� <br /> [ r 8 <br />