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- <br /> RD _ NON-HAZ�OUs WASTE MANIFEST <br /> WWII rWASTE TR NT AND DISPOSALFACILITY <br /> 111W. JOB ACCEPTANCE NO, r-m, ��� � � .� <br /> GENERATOR S-__ - �rf - . _._ REGIUIRED PER.SOR PROTECTIVEE©U1P ENT_ <br /> " ` , . .LL- - <br /> THRIFTY _ OIL_COMP,�,X_ N 'ra ❑GLOVES ❑GOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS ._ []TY-VEK ❑OTHER <br /> _ 100000 LAKWOODBLVD. j SPECIAL HANDLING PROCEDURES <br /> CITY,STATE,Z!P - - ' T•— T--�-- <br /> • DOWNEY,_ CA 90240 ' <br /> PH_ONE <br /> 310-92_3-9876_ <br /> CONTACT PERSON_ _a <br /> PETER D ' AMICO _ __ _ - _• <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE flATE­ <br /> .. IeLz< //=',';'- `F`/ <br /> WASTE TYPES _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • © DISPOSAL SOL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY `01L (209) 982- 1009 FAX <br /> 1250 N. WILSON WAY <br /> STOCKTON , CA <br /> NAME - MOTES - TRUCK NUMBER <br /> RICH HAMILTON TRUccING <br /> � - - <br /> ADDRESS <br /> 1336 PAULINE AVE. LOAD # 23 <br /> • CITY,STATE,ZIP <br /> MODESTO , CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 ;Q ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ,z ROLL-OFF(S) FLAT BED VAN DRUMS <br /> r( " ❑ ❑ ❑ ❑ <br /> * 4/ //"/7- 94,t <br /> FORWARD INC. LANDFILL cuBkc s - <br /> Forward shall have no obligation to accept the waste if weather or other 1 J ~ <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 STOc]CPIE_E 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-FRIABLE - <br /> ___ _ _ -_ _ ❑ ASBESTOS <br /> FACILITY TICKET NUMBER- <br /> -- - - _ _.�R �._ - �. .. _ .�.,- - - -- ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT �� - DATE <br /> - - '" ❑ ASH <br /> 't �w {� �t�� ❑ OTHER <br /> Sdff,bULNG 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(209)982-4298 2 7 6 5 3 <br /> MANIFEST # I v <br /> TRANSPORTER,COPY <br />