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A r. <br /> p- —� - NON-HA2 OUS WASTE MANIFEST <br /> WARR ' � � WASTE TRENT AND DISPOSAL FACILITY <br /> 14 <br /> ►NC. �Og`ACCEPTANCE NO. c - zee <br /> GENERATOR _ _ __ . - - - REQUIRE© 'ERSONALL PROTEGTIVE EQUIPME,NJ <br /> _ THRIFTY OIL COMPANY "" E]GLOVES-,❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILINGADDRESS- - � T -� ❑TY_VEK ❑OTHER---, <br /> 1000(]0 LAKEWOO€l BLVD. <br /> CITY,STATE,ZIP -T - SPECIAL HANDLING PROCEDURES " <br /> DOWNEY-, TA�9024© <br /> PHONE - ------- - <br /> • - 310_-923-9876 - - - �- -- - - <br /> CONTACT PERSON <br /> PETER D ' AMICO - - -- - - - - - - -_m <br /> SIGNATU,E OFaUHORIZE67ArGEN-r/TITLE DATE <br /> t <br /> WASTE YPE r _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> ® DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 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 � Gd <br /> ADDRESS <br /> 1336 PAULINE AVE. LOAD # 17 <br /> • CITY,STATE, ZIP <br /> MODESTO , CA XXXX 95359 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578--4100 P ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 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 /> r the waste C] SLUDGE <br /> REMARKS <br /> • -- J` - NON-FRIABLE <br /> ASBESTOS ASBESTOS <br /> FACILITY TICKET NUMBER _ <br /> - �� WOOD <br /> SIGNATURE <br /> SIGNATURE OF AUTHORIZED AGENT DATE _ <br /> ❑ ASH <br /> ❑ OTHER <br /> SCHEN ST BE MADE PRIOR TO 4.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> �SUBJ T TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL(209)9$2_4298 _ MANIFEST # 2 7 6 4 7 <br /> TRANSPORTER COPY <br />