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�t�L Nji.v r�..tr.� -�S/M�rf'e. rA - it <br /> 1 *-- -FORWARD NON-HAZARDOUS WASTE MANIFEST <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> rMd <br /> ED PERSONIRA:PROTECTIVE EOUMNT Bmida pcb,k FK]GLOVES [:]GOGGLES ❑RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ;ter es -'�`- z ❑N-VEK ❑OTHER <br /> 52 Wed Pim Shed SPECIAL HANDLING PROCEDURES <br /> iT <br /> • IockCA95245 1 <br /> (209)943-2011 _ <br />' �ONTAC7 PERSONS i�„�`'..�;':�V�4� •�.:,,��...��:.,:,�*`-�- =F�.,��:.. <br /> Nsvcs*Hosida _ 7 <br /> SIGNATURE OFA�H RIZED AGEI+I�TE�x��� DATE_ " , ,- <br /> 44 <br /> •F WASTE TYPE'S w��� _ "` ,:�`=�� .� 'sem -- - RECEIVING FACILITY <br />' ❑ SLUDGE FORWARD INC LANDFILL <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS <br />' • ] DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> •' ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATWG FACILITY .r_ r _ <br /> (209) 982-4298 PHONE <br /> ,191 N-awDftw 'o r (209) 982- 1009 FAX <br /> NAME - TRACTOR LIC # TRUCK NUMBER <br /> 9c3f 3� � O <br /> _ADDRESS {� 1 TRAILER LIC #_ <br /> I _g 3_ 1`4�kA l 1.1 _� U w H 5 S <br /> • CITY,STATE,ZIP TRAILER LIC # <br /> t r <br /> � 0'4r STU �U J� S END DUMP BOTTOM DUMP TRANSFER <br /> PHONE ❑ El rf F3`_�//�G <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL❑OFF(S) FLA-❑BED VA❑N DRUMS <br /> FORWARD INC. LANDFILL CUBIC YAR <br /> DS <br /> Forward shall have no obligation to accept the waste if weather or other I �✓ <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall use �� DISPOSE BIO AERATE STOCKPILE <br /> OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the <br /> waste for any reason If Forwards refusal to accept the waste is based on © SOIL <br /> weather or other site conditions Forward shall notify the Disposer when site <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> • REMARKS �/`� NON-FRIABLE <br /> ' 'y ❑ ASBESTOS <br /> FACILITY CKET NUyjR <br /> ❑ WOOD <br /> SIGNA URE O A�ORIZED AGE T DAT <br /> 7 i / — ❑ ASH <br /> f ./���� / ! ❑ OTHER <br /> ISCHEDULING 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 _ _ caI FS C[7PY MANIFEST # C71AR9 3 <br />