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FORWARM NON-HAZODOUS WASTE MANIFEST <br /> 4+ <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0, Lj I <br /> GENERATOR , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 9Wd*4 Petrok=Cooppa3r _ GLOVES [:]GOGGLES [:]RESPIRATOR HARD HAT <br /> MAILING ADDRESS HTY-VEK ❑OTHER <br /> 1905 Navy Dnw <br /> CI'T'Y,STATE, ZIP y - SPECIAL HANDLING PROCEDURES <br /> • Skiddo%CAS 9�it41C _ <br /> - PHONE <br /> (209}462-5707 <br /> CONTACT PERSON <br /> Jay mcuralk <br /> SIGNATURE_OF THORIZED AGENT/ TITLE":- DATE - <br /> '• i <br /> •" `WASTE WIDE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL I <br /> • DISPOSAL SOIL ❑ WOOD <br /> CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> E:1 STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> t <br /> ,GENERATING FACILITY <br /> is ,,cA - (209) 982-4298 PHONE <br /> 330D West <br /> (209) 982- 1009 FAX � <br /> ME TRACTOR LIC # yf&,}j i5,^-r' TRUCK NUMBER <br /> ADDRESS � _T�� - TRAILER LIC # I V f-,-)7 /`7 /0 ' <br /> • CITY,STA'T,f,ZIP _ - TRAILER LIC # <br /> PHONE"a` _ _ _ _ _ _END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR�DIVR DATE ROLL-OFFS) FLAT-BED VAN DRU S <br /> I <br /> RD!INC.,LA,NDF'ILL - ta�cc YARDS "a` <br /> Forward shat!have no obligation to accept th waste if weather or otherF <br /> conditions impair the safe and effective disposal oMhe waste or if the waste DISPOSAL METHOD; I <br /> impairs the safe an effective operation of the Landfill Forward shall use (TO BE CO PILE BY FORWARD) <br /> reasonable efforts to romptly notify Disposer of its inability to accept the _ DISPOSE BIO ARAE STOCKPILE OTHER <br /> waste for any reason'it Forward's refusal to accept the waste is based on - - <br /> weather or other site conditions, Forward shall notify the Disposer when site ❑ SOIL <br /> • <br /> 41,conVj1PRs are expected to change such that Forward will be able to accept } s I <br /> waste ❑ SLUDGE <br /> REMARKS <br /> • _ n^w ___ __ W_ _ -- _ - �___ — _ -_ _- ❑ NON-FRIABLE <br /> "W `--"-- --- ---- _ - ASBESTOS r ! <br /> �A�ILITY�TICKl;T NUMBER '- _ ""- <br /> _- _ ❑ WOOD <br /> ,GNAT Ell (qF AUTHOF)IZEb'AGENT DAAr�,�3"- 4"M <br /> 4 yp <br /> I � <br /> SCHEDULING 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 <br /> {209)982-4298 GENERATOR COPY C VC�I <br /> FO1{C9511NH)6 96 MANIFEST # C O <br /> i <br /> i <br />