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AMARM <br /> '_+ C <br /> IVWASETPH�MENT'ANDVDISP SAL FACILITY '` ` II <br /> If/tic. JOB ACG t�'fi/4 1 U. 93 — 544 <br /> GENERATOR.-,-:.,: _ . <br /> . -.a .,-�<� ,,.:,..,.r :�; REQUIRED PERSONAL PROTECTIVE-EQUIPMENT <br /> Riverside Cement n Company GLOVES []GOGGLES []RESPIRATOR <br /> D HAT <br /> MAILING ADDRESS ❑TY-VEK ❑OTHER <br /> f P.O. Bc1x4Q04 <br /> CITY,STATE,ZIP � ti �. : SPECIAL HANDLING PROCEDURES: <br /> Diatnond Bar, , CA. 91765 <br /> PHONE ; ,11! (f <br /> ! Z <br /> (909)683-3660 i <br /> n CONTACT PERSON <br /> Jean Kulusza ~ <br /> " SIGNATORr. F AU ORI AGENT/ TL DATE <br /> , �o -meq <br /> WASTE TYPE Y RECEIVING FACILITY;, <br /> u <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 /> Riverside Cement Company (209) 982-1009 FAX <br /> :X 2825 14. k4ashitwl-tort tit. <br /> 'itcckt.on CA <br /> NAME- g <br /> _: - � <br /> _.. . -NOTA U UMBE ' " <br /> Jim 1burpe Oil,Inc. <br /> �' ADDRESSY. <br /> U. Box 3�7 <br /> CITY,STATE,ZIP r. - <br /> ", Lodi, CA 95241-0357 <br /> - PHONE <br /> END DUMP;• - BOTTOMDUMP ..w TRANSFER <br /> El _. . .. ❑ <br /> F(S) . <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL,- FLAT=BED /AI�1DRUMS a <br /> 10- 'x'9) ❑ ❑ ❑' ❑ <br /> FORWARD INC. LANDFILL cuBlc YARDS, , t <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 <br /> DISPOSAL METHOD: TO BE COMPLETED BY FORWARD <br /> , <br /> impairs the safe and effective operation of the Landfill. Forward shall use ( <br /> ttt reasonable efforts to promptly notify Disposer of its inability to accept the DISPOSE ;-BIOS AERATE SiCSC <br /> waste for any reason. If Forward's refusal to accept the waste is based on "" <br /> D 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. ❑ SLUDGE <br /> n REMARKS - <br /> ❑ NON-FRIABLE <br /> FACILITY IiCKEf NUMBER "' <br /> ASBESTOS <br /> WOOD <br /> ' SIGNATURE QF AUTHORIZED AGENT" <br /> DATE `77- <br /> t ❑ ASH <br /> ❑ OTHER <br /> ^(a ir_IN II-ING M1)ST 13E MADE PRIOR 1�) i:Cp p.M. 'f l fr- l.)n'r rRlt:�t•, '10 EXI'EGI ED ARRIVAL ANY UNSCHEDULED LOADS ARE <br /> SlIn.Jr-ri TO nErtl4;Al., )r0j,1 ARRIVAI.., I)All Y 1117-1-W71,11-7s rnu;r f3E SCHEDULED WITH THE LANDFILL T14E 6AY BEFORE. <br /> T!> .-^.• ;tiFCit11_E CALL(209)982-1296 MANIFEST# 7872 <br /> ZnAt'!'I r Rtrn Cory <br />