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IVUIV—r1ALAhUUUJ VVAo I t MANIt-t8T <br /> FOWARDWASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACCEPTANCE NO. xr�`:cMN.=-� ^iiai�,p <br /> GENERATOR 7- -7777 "- REQUIRED PERSONAL PROTECTIVE EQUIPMENT _ <br /> THRIFTY OIL C D M P A N Y ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD MAT <br /> MAIU1 G ADDRK,§S�x —-h- _°^%; s s- _ � c' ❑TY-VE K ❑OTHER <br /> 100000 LAKEWOOD BLVD, <br /> CITY,STATE,ZIP '^- -T J"4 SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, ,CA 90240 _ <br /> 1W PHONE - - - - <br /> 310-923-9876 <br /> CONTACT PERSON <br /> PETER D ' AMICO <br /> SIGNATURE OF AUTHORIZED AGENT/ TITLE DATE <br /> WASTE TYPE ` RECEIVING FACILITY <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 /> THRIFTY OIL 209) 982- 1009 FAX <br /> 1250 N . IVIILSO'd ',JAY <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> RICH HAMILTON TRUCKING q 3� <br /> ADDRESS / <br /> 1336 PA€�LI:!!+ AVE . LOAD 4' 8 <br /> CITY, STATE, ZIP <br /> IODEST0 , CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2fCO-573--4100 Q ❑ ❑ <br /> SIGN TUBE OF AUT RIZED ENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obkgation to accept the waste if weather or other <br /> conditions impair the safe and effective disposall of the waste or if the waste DISPOSAL METH?DD (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 inability to accept the DISPOSE 610 AERATE STOCKPILE OTHER <br /> waste-for any reason If Forwards refusal to accept the waste is based on <br /> weather or other site conditions Forward shall notify the Disposer when site -� <br /> • conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKT `" <br /> • NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> __1 - - - ❑ WOOD <br /> SIGNA'rUR_�D�UTF ORIZE AGENT DATE _ <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 MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # 27638 <br /> TRANSPORTER COPY <br />