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._0NOWHAZA�US WASTE MANIFEST <br /> WARO� <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. <br /> �� <br /> GENERATOR ---- _ _ ��-- `' ;," _ REQUIRED]PERSUNAL PRC),ECT4VEEQUIPMENT — - <br /> _ THRIFTY OIL COMPANY []GLOVES [GOGGLES ❑RESPIRATOR [HARD HAT <br /> MAKING ADDRESS - -� r �" =� ❑TY-VEK ❑OTHER <br /> 100000 LAKEWOOD BBVff. <br /> CITY__STATE,ZIP ` s n SPECIAL HANDLING PROCDURES <br /> • ❑OWNE _CA 90240 <br /> - PHONE -_Y,- _ <br /> 310-923-3876 - - <br /> CONTACT PERSON - --�--- - -� <br /> - PItTER 6 ' AmICO _ <br /> SIGNAT_�JRE OF AfJTHORIZED AGENT I TITLE _ DATE _--- -- <br /> .. \ <br /> WASTE TYPE �,1 „ _ _ __ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ® DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <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 /> STOCKQTN , CA <br /> NAME - - _ NOTES -TRUCK NUMBER <br /> RICH HAMILTON TRUCKING f <br /> ADDRESS <br /> 1336 PAULINE AVE . LOAD #25 <br /> • CITY,STATE, ZIP <br /> • MODESTO , CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 0 _ ❑ ❑ <br /> SIGNAJUQE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BIrD VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC (AIDS <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 DISPOSAL 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 inability to accept the DISPOSE BIO AERATE STOCKPILE OTHER <br /> waste for any reason If Forward's refusal to accept the waste is based on IL <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 - - �- 4 y _ <br /> - - ---- _ NON-FRIABLE <br /> _ - _ _ _ _ .__ _ ... _ _ ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> __ _ _ _ _ _ _ _ _ ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE - <br /> - -- - �-- - - — -- ❑ ASH <br /> " ❑ OTHER <br /> SCH DU Wfa IJ§T BE MADE PRIOR TO 4 OU P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUB TO FUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL(209)982-4298 MANIFEST # 27655 <br /> TRANSPORTER COPY <br />