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i �i i i i i i � � � >• � �■■� �r �s�w. .w �On� FA n n ; ARVVAM NON-HAZARDOUS WASTE MANIFEST IL yy RD NON-HAZARDOUS WASTE MANIFEST WASTE TREATMENT AND DISPOSAL€A0UTY N C O R P O R A T E D WASTE TREATMENT AND DISPOSAL FACILITY RPORATE A / JOB ACCEPTANCE N0. FSM 2« JOB ACCEPTANCE N0. a -xQgbg JAt4ES M LANG- OH + l ammm GLOVES ❑6IT11. S❑RESPIRATOR ❑HARD HAT JAMES M LANGSTON ❑GLOVES 0GOGGLE813RESPIRATOR []HARD HAT ' K ❑TYVEK ©OTTIER MIG ADDfiESS�". - ©TY�IEK ❑CJRiER P O BOX 97 P 9 B O%�97 SPECIAL HANDLING PROCEDURES SPECIAL HANDLING PROCEDURES Yi 5L4TELZlF' SVQ�ZIFx_`_ -� F'- • LATHROP CA 95330 _ LATHROP t CA 95330 _ „', }` 209-957-5981 OONpYGT 90ON1t7LE JAN HENRICKSON MM- JAN H E f I R I C K S O V SIGNATURE OF AItIF�pRgED 7 TIfL ” SIGNAIUF)E OF AUTNDRl ED AGENT 1 TTCLE DATER"=v'« 7 _ 't-,"Ai, -6- WASTE TYPE ,-,.,,_yf, RECENNKi FACILRY_ i4 • VWS'rE TYPE RECEIVING FACILITY _ ❑SLUDGE TREATMeNr solL "°"FRLABIJ;AseEsros FORWARD INC LANDFILL ❑ SLUDGE ❑ TREATMENT SOIL p NON FRIABLE ASBESTOS FORWARD INC LANDFILL ❑ ❑ T • p DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD ❑ TREATMENT T S p CONOSAL SOIL SOIL p ASH 13�Y000 9999 SOUTH AUSTIN ROAD ❑CONSTRUCTION SOIL ❑ASH ❑OTHER cT"C""tz MANTECA,CALIFORNIA 95336 E)OTHER `'T'"�P�L; MANTECA,CALIFORNIA 95336 • GENERATIIVGFACIUTY (209)982-4298 PHONE GENERATING FACILITY (209)982-4298 PHONE Lj ,',�T� rs " yT -- Ly ,'T, "= A-_T r TIC L _,3t_= 3_,r+_ IT ,T (209)982-1009 FAX 15.1= c °r1T4 :T ( )982-1009 FAX C LcTHROP, CA NOTES TRUCK NUMBER NAME NOTES. TRUCK NUMBER NAME T" : � h N:r,I�TJr: 9irilr ni.rG _ r i ADDRESS I Y fz S2 B B i 3c AP ILI IE VE L-11 V 2== - ZFF�"Li'+` -AD - = CTfY STATE ZIP M4 CITY&�A + y J ��: � r PHONE END DUMP BOTTOM DUMP TRANSFER END DUMP BOTTOM DUMP TRANSFER - SIGNATYII$E 11 13 11 SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT BED VAN DRUMS it.l46C` EO+GENT OR DRIVER DATE ROLL-&F(S) FLAT-BED VAN DRUMS * �t ...,C- J it - CUBIC YARDS I r CUBICYAROs FORWARD INC LANDFILL FORWARD INC LANDFILL ; i ! Forward shalt hese no pbYpalron to accept the waste d weather a Taber Forward Ma have no eblpetrdn to accept the waste d weather a other J eonatrons rmpaa the safe and eNeCave deposal of the wase or e Ore waste DISPOSAL METHOD (TO BE COMPLETED BY FORV"D) cormions impar Ore safe and eflactwe deposal d the waste or d the waste DISPOSAL FAETFIOG- 8E COMPLETED BY FOFiY1l4R01 ehpaas the sate and etlecu aoeradon ot the LaMill Forward shall use SE BIO JAERATE 570Gr(Paf OTHER arrpan am sats and afloat-operat+on d the Lmtdl Forward atr.tl use 810 AERATE OTHER rsasonabte shorts td PDROh'WWY Deposer ot as arablrty to acCepr the reasarrbk Nlorts W txamptH ndrH Orsooee+d its nsGlly t0 accept iha _,_ waste tor any reason.d Forward s refusal to accept the-sate a based on wasu for reason.s Forward s rob"to accept the wase Is balled on weather or other srte conddroes Forward shad notdy the Deposer when site ❑�� weather or other sae condrt o w Forward shad ndtdy the Dmpbser when ale ❑SOIL andirons are expected to charge such that Forward m&De able to accept ca'dbons ars expected to charge such that Forward wdl be able to 30C W the waste ❑SLUDGE • the waste ❑SLUDGE REMARKS Nott FRIABLE REMARKS +{ - A. ASBESTOS e ©ASBESTOS FACILITY TICKET NUMBER F��i�AABER ❑WOOD ❑WOOD SIGNATURE QrAU7HOR121r0 F qW DATE SIGNATUPEI�AL1 HODATEASH ASHk HER ER Ism SCHEDULING MUST BE SC1iE0ULING MUST"BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE MADE PRIOR TO 4 00 P.M THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE THE LANDFILL TH SU$J£CT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE SUBJECT TOWFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH E DA��Yyy BEFORE TO SCHEDULE GALL L UP 9B2 4498 AT B TO SCHEDULE CALL(2001 982 4298 MANIFEST- 53 V 9 8 MANIFEST e 5 3 U 9 7 GENERATOR COPY GENERATOR COPY