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� MENOMONEE 10001=0,)ORWARL) i i � � � IIIIIIIIIIII■._ NONDoW wAsrEr MANIFEST ' INCORPORATED VA STE TREXrMENT AND DISPOSAL FACUTY 1 OR1► T} I, JOB ACCEPTANCE N0. j J NON-HAZARDOUS WASTE MANIFEST / I N C O R P O R A T E D WASTE TREATMENT AND DISPOSAL FACILITY JOB ACCEPTANCE NO CMH - 4402 JAMES M LANGSTON ❑GLOVES ❑ GG GOLESQRESPIRATOR ❑HARD HAT ,- ❑T(VEK ❑OTHER GENERVOR. _ .�� _ __r� REOUIRMIREFECNAL-PROTECTIVEEQUPMENT P 0 BOX 97 - SPECWLHANDLING PROCEDURES ,IAjL,_=$ ..�a� ❑GLOVES ❑GOGGL ESDRES PIRATOR —OKAR— DW ❑TY1EK ©OTHER LATHROD CA 95330 SPECIAL HANDLING PROCEDURES 209-957-5981 CITY zw1P _ JAN HEPI FCKSOk �rG-Ors-r�."._T r� ..t��w �•-w- t CONV+GT PERSON _ _ -- * JAF `- -nt SIGNATURE 'AGENT/zmE OATE/ RECEMNG FACILriY ❑ TREATMENT SOIL ❑NON-FRSLUDGEIABLE ASBESTOS FORWARD INC LANDFILL TT RECEnnNGFALaLrrY —� • ❑ DISPOSAL SOIL ❑WOOD ❑ SLUDGE ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD ❑ TREATMENT SOIL 0 NON-FRIABLE ASBESTOS FORWARD INC LANDFILL • ❑ OTHER STD.;pTLE MANTECA CALIFORNIA 95336 ❑ DISPOSAL SOIL ❑ WOOD ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD GENERONG FACILITY (209) 932-4298 PHONE " ❑ OTHER ; MAPJI ECA, CALIFORNIA 95336 LA4i 5T41 '3 BAIT TA!' LE • (209) 982-1009 FAX GENERATINGFACLLRY (209) 982-4298 PHONE LDT46%, C4 ;_,-, ,j'S; - (209) 982-1009 FAX NAME NOTES TRUCK NUMBER ',-14 HA ITLTO?' TY,ICFT IS CJ` 1) 13,57 ADDRESS NAME NOTES ,r TRUCK NUMBER 1"-S PPUL-- IE A tC _,113 _ ,'+ - _ tip • TIFC CITY STATE ZIP ADDRESS - - C3cSTO CA 3�z 5 P PHONE, END DUMP BOTTOM DUMP TRANSFER CITY STATE ZIP, SIGNATURE OF AUTHOR=AGE; OR DRIVER DATE ROLL-OFFS) FLAT BED VAN DRUMS PHONE END DUMP =OM DUMP TRANSFER L] ❑ ❑ 0 2rc,-7C--1GO © ❑ G SIGNATURE OF AUTHORIZED AGENT OR DRNER DATE ROLL-OFFS+ FLAT-BEC VAN DRukis FORWARD INC LANDFILL :URIC YARDS _ * + -� ✓r ~' �✓ l Forwale snail nave no oUrp=n to accept the waste R weather or other I '` CUBIC YARDS conWom moss the safe and ea°ctxe deposal al the resfe or it the waste DISPOSAL METHOD (TO 8E COMPLETED BY FORWARD) INC LANDFILL eripaas the este and etenwe Weraton ct the Lertl N Forwam Ahab Lae reasoriabe et M to ommotty robty Depow o[as wabil'rsy to accept the _ POSE Bio AERATE ls'xmz OMrw EP Forward sl nave m onl�tOn to accept the waste a weather or other waste for arty raasdn.If Forward a rtkml to swept the waste a based or comim's Lipar the sate mhd eflectne deposal LN the waste or d the waste weather or other ser tend limm Format shalt vhty the Deposer when so ❑SOIL I enpairs the ease and of ectrve oo mim of the LandfiP Forward she tae DEPOSAL METHOD- Il0 BE iAMFLETED BY FORYM4RD corMms are expected to Cw9e such the F�rwmre wLiP be able t7 accem reasonaW emorm to Drornotly nddy Dispose or as ahapdny to accept the uGSPQSc BIC AE RAT= -,I=l OTHER the waste �❑SLUDGE waste for am reason a Forwards Wu5al to accept the=a based on IL • REIvIARl6 weather or WrKid&Z are expected to chanpeWnWa �such that werd sheEForwa d will able toheaocept NON-FRLABLE I the waste _ __ p SLUDGE FACILITY ET NUMBER - ❑ASBESTOS ! ` REMARKS _ _ F ---~ r•-� NON-FRIABLE /^ ! D WOOD - _ _ _ _ S`IGNATU�F AUTHO AG ! DATE FAPIIJTY TICKET NUMBER ASBESTOS �-- 7 ❑ASH ❑WOOD SIGNATPLE OFIIED AGENT ' OTHER I //� ❑ASH y � SCHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARAML a ANY UNSCHEDULED LOADS ARE * WJ '✓"v � ` ❑OTHER SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED wLTH THE LANDFILL THE DAY BEFORE TO SCHEDULE CALL(209}982.4$98ji�Q�' SCHEDULING MUST BE MADE PRIOR TO 4-OD P M THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS AF MANIFEST- t++ Vu SUBJECT TO REFUSAL UPON!ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WRH THE LANDFILL THE DAY BEFO 0GENERATOR COPY TO SCHEDULE CALL(209)982-4208 56589 _ _ MANIFEST