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IVAN" Ivvly nr�r_�r1uvv0 vvr�0Ic IvlrllvlrwI <br /> `✓ WASTE TP -MENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. - <br /> -- <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENTS » r <br /> Riverside Cement Company ©GLOVES ❑GOGGLES ❑RESPIRATOR HARD HAT <br /> MAULING ADDRESS ❑TY-VEK ❑OTHER <br /> t CITYfiAiZIP4904 - SPECIAL HANDLING PROCEDURES: <br /> 1 i <br /> Diamond Bar, CA. 9176 <br /> C.20 <br /> iT (909)683-8600 <br /> t{ CONTACT PERSON <br /> Jean Kukusza <br /> SIGNATURnF RUTH ED NT/TI DATE. <br /> !/ <br /> rt WAS TYPE777 ,. RECEIVING FACILITY =: .. .. ,. <br /> . .t , taw <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> Q 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 /> 2825 Y. Vlashington >t. <br /> "tt�cl;tin, CA <br /> NAME •NOTES4. � <br /> r »; RIiK NWMBE <br /> Jim Thorpe Uil, Inc. <br /> , ADDRESS 2-2C <br /> P.U. Roy 357 <br /> CITY,STATE,ZIP <br /> Lo:+i, CA 95241-0357 <br /> - PHONE <br /> (2_'09) 359-6175 END DUMP BOTTOM DUMB TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL.OFF(S) FLAT-BEVPVAND❑LIMB' ` <br /> El <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other 1 f' <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 4,BI0 : AERATE SiDCIS??It tT1}1ER <br /> waste for any reason. If Forward's refusal to accept the waste is based on <br /> n 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 /> ❑ SLUDGE <br /> r n REMARKS 77 - <br /> r ❑ NON-FRIABLE <br /> 1 FACILITY TICKETNUMBER rw j :;? ";' '� ASBESTOS <br /> El WOOD <br /> ( SIGNATURE OF AUTH6RIZED•AGENT m r: DATE :v=: , „ <br /> _ ❑ ASH <br /> ( ❑ OTHER <br /> E <br /> j <br /> !:!;l 11711111 IPI, MUST IAF MADE 1'111;08 -1:0r) rn1. Tlit- DAY rnion To rxr`Cr,iEU Af,111VAL • ANY UNSCHEDULED LOADS ARE <br /> I 'T!t 11FFOSAl_111" 91)AnnlVAI_ of tc,i JIpt,I_�AII Y DELIVF_TIIE=:WIS 1 BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TO G!atr;nt.fl_E CALL(20A)9x,12-42nf; <br /> MANIFEST# 7875 <br /> TnANsroriiE-n Cory <br />