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WA RD <br /> p ,,"- 4�UN H�AHUOUS WASTE MANIFEST <br /> WASE TREATMENT AND DISPOSAL FACILITY <br /> II'rIC- -JOB ACCEPTANCE N0. CAM <br /> Z:1 <br /> 4 <br /> GENERATOR _ _ _ _ _ _ _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> THRIFTY OIL COMPANYF' ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> MAILING�DDR ❑TY-VEK ❑OTHER <br /> s <br /> 100000 LAKEW000 BLVD , <br /> CITY,STATE,ZIP ` " ` ""r ' -`'' ~ SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, CA 90230, <br /> ~ <br /> 310-923-987$,- <br /> CONTACT PERSON <br /> PETER D` ArMIC0 <br /> SIGNATURE OF A THORIZED AGENT/ TITLE DA <br /> Y6 F3oar'rm I 17s� <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NDN-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • `0 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 OTES,_____ -` TRUCK NUMBER <br /> ADDRE%;CH HAMILTON TRUCKING <br /> lP AULINE AVE. LOAD 4 5 <br /> CITY, AR <br /> PHONE C D�' T 0 ' A 05359 END DUMP BOTTOM DUMP TRANSFER <br /> 'i O 7 ��^ El El 11SIGNA '4 ZlTHORIZ-;1ED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS 1 <br /> Forward shall have no obligation to accept the waste if weather or other i T <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 +nabiltty to accept the DISPOSE BIO AERATE STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on -`SOIL <br /> weather or other site conditions, Forward shall nota the disposer when site Li <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 TICKET NUMBER <br /> El WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> f r <br /> ❑ ASH <br /> ` ❑ OTHER <br /> SCHEDULING"MUST 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 MU9'rj5E SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209)982-4298 MANIFEST # 27636 <br /> TRANSPORTER COPY <br />