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F04WA _ NON-HAZC)OUS WASTE MANIFEST <br /> RD WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE N4. s2819 �'y <br /> GENERATORULF__ _� REQVURED PERSONAL PROTECTIVE E Q IP NT _ <br /> __THRIFTY OIL COMPANY [—]GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARDHAT <br /> MAILING ADDRESS ` _ x ' r� - ❑TY VEK []OTHER <br /> - -- 1a000a� ao <br /> LAK�� D si:vfl. _ <br /> CITY,STATE,ZIP OO SPECIAL HANDLING PROCEDURES <br /> • DOWNEY_,_ CA 90240 <br /> PHONE <br /> 310-923-9876 <br /> CONTACT PERSON - - <br /> 0ETER- D'a1io <br /> SIGNATURE OF AUTHORIZED AGENT,, fii DATE <br /> WASTE TYPE - RECEIVING EACILITY <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 /> STOCKTONJ , CA <br /> NAME I 'NOTES TRUCK NUMBER <br /> RICH HAMILTON TRICKING q �� <br /> ADDRESS I <br /> 1336 PAULINE AVE. LOAD# S <br /> • CITY, STATE, ZIP <br /> MODESTO , CA 95355 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 10 ❑ ❑ <br /> SIGN TURE OF AUT RIZEDrNT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ El El El�k <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shat}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 METH D (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 theDISPOSE 910 AERATE SmoiLE OTHER <br /> waste,.or any reason If Forwards refusal to accept the waste is based on <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 _ <br /> ❑ SLUDGE <br /> REMARKS—`- <br /> ❑ HON-FRIABLE <br /> AGILITY TICKET NUMBER ASBESTOS <br /> -- _ _ ❑ WOOD <br /> SIGNOUR U ]RIZE AGENT DATE <br /> ❑ ASH <br /> 7k (� f/�I/ ❑ OTHER <br /> SCHEDULING 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 DAILYELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209)982-4298 ?Q <br /> y MANIFEST# 2 r7 6 J 8 <br /> TRANSPORTER COPY ' <br />