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'���� IVVIv I Ir1Lll <br /> llLlVVV •.l1Vr` uun <br /> r. . iv. <br /> ' WASTE TF TMENT AND DISPOSAL FACILITY <br /> I C. �../ <br /> JOB AOCE:RTANCE NO. 93 — 544 <br /> GENERATOR �. �:�; ,. _ x � sem, REQUIRED PERSONAL PROTECTIafE,BQ1�IPMENT�,`;, <br /> Riverside Cement Company H QGLOVES GOGGLES ❑RESPIRATOR ®HARD HAT <br /> MAILING ADDRESS ❑TY VEK p OTHER <br /> P.O. Box 4904 <br /> CITY,STATE,ZIP + - "` "" SPECIAL HANDLING PROCEDURES: <br /> .. ' <br /> .. Diamond Par, CA. 91765 C20 <br /> PHONE <br /> CONV8 �&A*60 <br /> Jean Kulusza <br /> SIGNATURE IZED AGENT/TITLE . _ DATE `.rz <br /> ti WASTE TYPE RECEIVING FACILITY ,i ; , y 'y,�' '* . <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> DISPOSAL SOIL ❑ wooD 9999 SOUTH AUSTIN ROAD <br /> ,� ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> Riverside Cement Company (209) 982-1009 FAX <br /> ?e25 's, blashington St. <br /> t rcpt on, CA <br /> NAMEa —NOTES:,­ 0&-NUMBED <br /> Jim Thorpe Oil, Inc. <br /> ADDRESS @—?_C <br /> P.U. Box 357 <br /> CITY,STATE,ZIP k <br /> Lodi, CA 95241-0357 <br /> PHONE - END DUMP ;,< . BOTTOM DU <br /> MP, .. <br /> (201))368-6175 <br /> - SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE .-,ROLLrOFF(S) FLAT-BEDa VANS DRUNMS�':. <br /> -�I; <br /> FORWARD INC. LANDFILL CUBIC,-YARDS , <br /> Forward shall have no obligation to accept the waste if weather or other 1 R <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 /> n reasonable efforts to promptly notify Disposer of its inability to accept the ;, DISPOSE x;BlO AERATE;STOCKPILE OTIiEI�as <br /> waste for any reason. If Forward's 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. ❑ SLUDGE <br /> ` REMARKS ' <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> FACILITY TICkEf NUMt3ER <br /> ❑ WOOD <br /> SIGNATOR QFA ORIZED AGENT,, j T : DATE <br /> i % I J ❑ ASH <br /> -- _, I ! , _ I(} �-r ❑ OTHER <br /> i <br /> I S(A IFJ1111 ING MUST BF MADE f RICIR to /I:ofj r.na. 'Tttr r)AY PRIM(, 'fU EY,PECIED ARRIVAL ANY UNSCHEDULED LOADS ARE <br /> t c11n.Irm 10 RFri lSAL t tr(lh•l ARRIVAL..ONG,011J(,DAILY DE.LIVERIE. MUST Rr SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> rcI SCI IFDULE CALL(20P) 992-120S MANIFEST# 7874 <br /> Inmirr+rill IFr1 cc)ry <br />