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FORWARD , NON-HAZARDOUS WASTE MANIFEST <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C'J�'�k t j 0-f S h J'a q Lf ❑GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS t y -� ' r �" ' ❑TY-VEK []OTHER <br /> (t?? E jco7t5 Av' aUe_- <br /> CITY, STATE, ZIP SPECIAL HANDLING PROCEDURES <br /> -- ' - # 0 ,t + GA 9SzcS <br />' - PHONE <br /> i � ti9` fag — 33 � ? <br /> CONTACT PERSON <br /> [30� Nuc Mot Ile '1. <br /> SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br /> t f L I-ZI 9q <br /> t t <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br />' ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • 2C DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 50:11 TvtJL4fj CdNhfy <br /> AgrscHj#uruf Co'4tln�fsStDt,� fY�S Df�ft: Q (209) 982- 1009 FAX <br /> 1;03 �asf W4 Strlit <br /> TV-acV CaIt f01-oft 4— <br /> NAME NOTES TRUCK NUMBER <br /> To rA y Ciaoi ev e-- <br /> ADDRESS <br /> • CITY,STATE, ZIP <br /> Kahc �fv (�+�r+ p w# C A 5S 6 $ 3 rr <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (946 ) 35tf- 31rO ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARD$ <br /> Forward shall have no obligation to accept the waste if weather or other ' T 7L Um <br /> condit¢ons impair the safe and effective disposal of the waste or it 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 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 <br /> NON-FRIABLE <br /> FACILITY TICKET N,UMB,F�t ) ❑ ASBESTOS <br /> II � , ❑ WOOD <br />' SIGNATURE� F Ay f I�D A N7 IAT <br /> 1 l i E] ASH <br /> .i// r� ` ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED TOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEQUL$ CALL (209)982-4298 <br /> GENERATOR C(-FY MANIFEST # 83208 <br />