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ARDt j _ x NON-HAZ OUS WASTE MANIFEST <br /> - .f .Y , WASTE TRENT AND DISPOSAL FACILITY <br /> ' JOB ACC P "ANC NO. tr:,Cj4 �1286wv <br /> Pl IVERATOR y ;r k', . . . -u`:'. __ _ ._—PEIQUERED PE�iSONAL PROTECTIVE EQUIPMENT' _ <br /> THRIFTY OIL COMPANY a ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> , lTY-VEKLINGADDRESS _ OTHER <br /> 100000 LAKEWOOD BLVD. <br /> J , <br /> � Y SKATE,QIP R ! SPECIAL HANDLING PROCEDURES <br /> DOWNEY,_qA 90240 <br /> PHONE <br /> 310-923-9976 <br /> CONTACT PERSON(— _ <br /> PETER 07 AMICO _ _ <br /> SIGNA RE OFA THORIZED AGENT!TITLE DATE <br /> WAST�7YPE _ _ RECEIVING FACILITY <br /> r ❑ 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 /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> ADDRE�SH HAMILTGN TRUCKING <br /> 13T36 PAULINE AVE . LOAD # 21 <br /> CITY,S ATE, ZIP <br /> • PHOS D`S I O ' CA 95358 END DUMP BOTTOM DUMP TRANSFER <br /> 209-573-4100 MX ❑ ❑ <br /> SIGNATURE OF AUTH RIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> f ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other f <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 w DISPOSE BIO AERATE STOCKPILE OTHER <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-FRL4BLE <br /> .. _._.. __ _ _ _ _ _____, ❑ <br /> FACILITY ASBESTOS TICKET NUMBER y <br /> - - - - ---- -- - — -- . —--_� .... _ - ❑ WOOD <br /> SIGNATURE pF AUTHORIZED AGENT �' DATE- ' <br /> ❑ ASH ^` AL <br /> ❑ OTHER <br /> SCRtDUUffG MUST BE MADE PRIOR TO 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULEIp LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY 13EFORE <br /> TO SCHEDULE CALL(209)982-42982?65 1 <br /> ANIFEST # <br /> TRANSPORTER COPY <br />