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,-4lOfN-HAZ�OUS VVASTE MANIFEST <br /> WASYE TR ENT AND DISPOSAL FACILITY <br /> ZINC. JOB ACCEPTANCE NO. m CHM' _* 128 <br /> GENERATOR_ __ REQUIRE©PERg0I A..L PROTECTIVE EQUIPMENT r <br /> THFHIFTY OIL COMPANY [-]GLOVES [:]GOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING�1DldRESS -"t'A - ❑TY-VEK [:]OTHER <br /> 100000 LAKEWOOD BLV©, <br /> CITY STATE,ZIP SPECIAL HANDLING PROCEDURES <br /> - _ ' � j <br /> • _ OOWNEV_, _CA_ <br /> PHONE _ - <br /> 310-923-987$x, <br /> CONTACT PERSO <br /> -PETER D'AMICO_ <br /> SIGNATURE OFAUTHORIZED AGENT/ TITLE_ -_ DA_ <br /> • WASTE TYPE. _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ;® DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ _ (209) 982-4298 PHONE <br /> THRISTY OIL 209 982- 1009 FAX <br /> 1250 N . WILSON WAY ` <br /> STOCKTON , CA , <br /> NAME NOTES TRUCK NUMBER <br /> ADDRE CH HAMILTON TRUCKING � <br /> q'1_ <br /> • CITY, SJ ,6ZI�AULINE AVE. LOAD # S <br /> • PHONIMODESTO, CA 95358 <br /> END DUMP BOTTOM DUMP TRANSFER <br /> {{;;cc]]_ _ <br /> SIGNAM Q AZTII(IR ED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED❑ VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> l r 4 <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 BIOAERATE STWIPILE OTHER <br /> waste for 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 SOIL <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste+ <br /> REMARKS ❑ SLUDGE <br /> . -- ---- - - - ___ ❑ NON-FRIABLE <br /> - <br /> FACILITY TICKET NUMBER ASBESTOS—' -- <br /> -- - - - --- - - ❑ WOOD <br /> - SIGNATURE OF AUTHORIZED AGENT DATE _ <br /> ASH <br /> {5 �I ❑ <br /> ❑ OTHER <br /> SCNEbULIN UST 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 MU SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SrsHEDULE CALL(209)982-4298 �• <br /> MANIFEST # 2 7 6 3 6 <br /> TRANSPORTER COPY <br />