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-'FOR'M.RLJ NON-HAZARDOUS WASTE MANIFEST <br /> 1 v►b <br /> IN C O R P Q ]�A TED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO <br /> GENRATOR�; <br /> �-' <br /> 1 �.x REQUIRED PERSONAL PROTECTIVE EQUIPMENT, <br /> P W _ ®GLOVES ❑GOGGLES []RESPIRATOR ®HARD HAT <br />' MAILINGYADDRESS _Pfine <br /> 3Dl►est Street Y ❑TY-VEK OTHER <br /> 21 <br /> CITY.STAT!`,ZIF _ - SPECIAL HANDLING PROCEDURES <br /> w I0dLCA 95245 <br /> t2O9)943-2011- - <br /> - <br /> SIGNATURETOF AUTHORIZED AGENT/ TITLE DATE <br /> A .. <br />' WASTE TYPE RECEIVING FACILITY <br /> SLUDGE <br /> ❑ TREATMENT SOIL � <br /> DISPOSAL SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> El ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> " ❑ STOCK PILE El OTHER <br /> • MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> �- - ---- v - TRACTOR LIC # TRUCK NUMBER <br /> ADDRE �`� <br /> t � Y I ��,J ►, ' L �'��` >'� �C' <br /> SS / TRAILER LIC # <br /> • <br /> CITY,STATE, ZIP TRAILER LIC # � <br /> PHONE <br /> ENIt,D MP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGIENT OR DRIVER DATE f ❑ ❑ <br /> ROLA!�FF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> t �! <br /> r � <br /> �fFORWARD INC. LANDFILL CUBIC YARDS <br /> For shall 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 <br /> impairs the safe and effective operation of the Landfill Forward shall use DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE BIO I 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 LJ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste <br /> * REMARKS ❑ SLUDGE <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ <br /> SIGNATURE OF AUTHORIZED AGENT DATE ; <br /> WOOD <br /> � f ❑ <br /> f�7,�,' ASH <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4 00 PM I <br /> M THE DAY PRIOR TO EXPECTED ARRIVAL • <br /> ANY UNSCHEDULED LOADS ARE <br /> ISUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> O SCHEDULE CALL (209) 982-4298 <br /> 7{G9511NH}6 9$ <br /> SALES COPY — MANIFEST # C rj f;1247 47 <br />