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NON-H OUS WASTE MANIFEST <br /> WWARD WASTE�ENT AND DISPOSAL FACILITY <br /> ~ I1VC. <br /> ' JOB ACCEPTANCE NO. c"M x 1288d' " { <br /> GENERATOR _ _ �r` ._ " _L - �._, REQUIRED PERSONALFROTECTIVE EQUIPMENT__ <br /> THRIt`TY�f} L $�fRlIMQ COP4P�4X E]GLOVES ❑GOGGLES ❑RESPIRATOR [:]HARD HAT <br /> MAILING ADgRESS M� '� [:]TY-VEK ❑OTHER <br /> 100000 LAKEWOOD BLVD. <br /> CITY,STATE ZIP SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, CA__90240 �- <br /> PkE __ _ <br /> 310-923-9875 <br /> CONTACT PERSON! <br /> PETER D' AMICO -- <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE % _ _ _ _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD t <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ (209) 982-4298 PHONE <br /> THRIFTY OIL (209) 982- 1009 FAX <br /> 1250 N . WILSON WAY <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> RICH HAMILTON TRUCKING <br /> ADDRESS <br /> 1336 PAULINE AVE . _ ; , � ;ter . ` LOAD # 31 <br /> CITY,STATE, ZIP <br /> MOCIESTO , CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209=S7$41 U " L7 ❑ <br /> SIGNATU U D AGENT OR DRIVER DATE _ ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ " ❑ ❑ ❑ <br /> Ile <br /> a <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other <br /> conditions impair the safe and effective disposal of the waste or if the waste DIS OSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impairs the safe and effective operation of the Landfill Forward shall use <br /> reasonable efforts to promptly notify Disposer of its lnabildy to accept the DISPOSE BIO AERATE STOCKPII E OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on IL <br /> weather or other site conditions, Forwarckshall notLty=the Disposer when site <br /> • conditions are expected to change such that Forward will be able to accept ` <br /> the waste ❑ SLUDGE <br /> • REMARKS - W _ -- - - -- — - <br /> - NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> _ _ __ .. _ -- --- — --- - - ❑ WOOD <br /> SIGNATU OF ORIZE AGENT - _ DA r <br /> � - - - — - - ._ ❑ ASH <br /> 7�C �_ � ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR Tb 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 WITA THE LANDFILL THE DDAYBEFORE <br /> TO SCHEDULE CALL(209) 982-4298 MANIFEST # 27661 <br /> TRANSPORTER COPY <br />