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1VVIV flP1L_/1flVVU�7 YY/1J1C IVIl11VIrC�71. ' <br /> •' WASTE T'^ NTMENT AND DISPOSAL FACILITY <br /> AMC.OXJOS ACCEPTANCE — <br /> /�,I�I � (��. �3 544 <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMEhR =' <br /> Riverside Cement Wmpany n GLOVES []GOGGLES ❑RESPIRATOR �HARD NAT <br /> MAILING ADDRESS ❑TY-VEK [:]OTHER <br /> P U'` BOX SPECIAL HANDLING PROCEDURES: <br /> CITY,STATE,ZIP SPECIAL <br /> _...Ufamond. Bar. CA 91765 <br /> PHONE C.20 <br /> ri (909)683-3660 <br /> n; CONTACT PERSON <br /> Jean Kulusza <br /> SIGNATURE F UTH •ED NT/'n ATE <br /> 1 n WASTE TYPE ., RECEIVING FACILITY , <br /> f u <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> [] DISPOSAL SOIL ❑ WOOD <br /> a ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> Riverside Cement Company <br /> E2925 W. Wa3hington St. (209) 982- 1009 FAX <br /> Stockton, CA. <br /> j NAME �,, � *T .. K . <br /> Ji;;l Thorpe Oil, Iitc - ..... � .- <br /> UMBER"�>. <br /> .. U . <br /> ADDRESS 2-2C <br /> Y.O. Box 357 LO <br /> "s CITY,STATE,ZIP <br /> Lodi, CA. 95241-0357. <br /> PHONE <br /> END DUMP , ,BO,TTOM DUMP,��,i; ,TRANSFER <br /> (:(191)W1-6175 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ? ROLL-OFFS) FLAT-BEb,�''`* VANbRUMS ' <br /> El <br /> FORWARD INC. LANDFILL cuBlc YARos4,4 <br /> Forward shall have no obligation to accept the waste if weather or other 1 <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 /> tt reasonable efforts to promptly notify Disposer of its inability to accept the. ;Tse >•: DISPOSE ,613; : AERATE SGKPILE <br /> waste for any reason. If Forward's refusal to accept the waste is based on, " <br /> T1 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 /> htMARK3'�r•-' `.. , ^� ,x., ;z. y rx ❑ <br /> ❑ NON-FRIABLE <br /> 1 - r ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> SIGNATURgOF AUTHORIZED AGE T_ y DATE -,. <br /> ❑ ASH <br /> ❑ OTHER <br /> i <br /> ( S( 11x1?rH-ING MUST BE MADE MOP 1cl 4:t)() r .m. 111E D/f PRIOR TO EXPECTED ARRIVAL ANY UNSCHEDULED LOADS ARE <br /> I S11ff.IFc;T TO REFUSAL MON ARRIVAL,CNVC:V11" ,DAILY 111713VERIES MU ST BE SCI IEDUI_ED WITH THE LANDFILL THE DAY BEFORE. <br /> 1(.) RC;IiFDt.1LF_ CALL(209) 982-42PF3 MANIFEST# 7873 <br /> 1T1ANP-r'C"1RTF:n cory <br />