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INUIN-rA4AhuUUS VVW51 L MANWLST <br /> Fr�wGRHAROWASTE TREATMENT AND DISPOSAL FACILITY <br /> 3 J68 ACCEPTANCE NO. 12 <br /> Q 0 f <br /> .2A <br /> GENERATOR REQUIRED PERSONAL,PROTECTIVE EQUIPMENT <br /> THRIFTY- OIL- COMPANY v a Y.-.n4�-,r��� r,_ _ � ❑GLOVES E]GOGGLES ❑RESPIRATOR [:]HARD HAT <br /> MAILIfVG ADDRESS„ ; �` - ❑TY-VEK ❑OTHER <br /> 1OOGOO LAKEWOOD_ BLVD._ �;....r ---_ , <br /> CITY,STATE,ZIP _ y �— SPECIAL HANDLING PROCEDURES <br /> _. _ _ �. ._ �s ._ 1`_ . <br /> • DOWNEY, CA 90230, - - <br /> PHONE <br /> 310-923-9876 <br /> CONTACT PERSON W <br /> PETE; D `AMICO y <br /> SIG NA URE OF�UTHORIZED AGENT/ TITLE DATE <br /> kvr <br /> WASTE TYPE RECEIVING FACILITY <br /> ' ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • p DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTV OIL <br /> 1250 nI . 14ILSON 0AY (209) 982- 1009 FAX <br /> STOCKTON , CA <br /> NAME, NOTES TRUCK NUMBER <br /> RICH HAMILTON TRUCKING <br /> ADDRESS c' <br /> 1335 PAULINE AVE . LOAD #12 <br /> - CITY, STATE, ZIP <br /> "ODESTO CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 © ❑ ❑ <br /> SIGNATURE OF AUTH RIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste ifweather or other 12 e3 <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 inability to accept the SE 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 notify the Disposer when si <br /> " conditions are expected to change such that Forward will be able to accept <br /> the waste CO] SLUDGE <br /> REMARKS <br /> NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> ❑ WOOD <br /> WN/�T FSE OF�UTHO ZED AGENT DATE <br /> L [IASH <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 # 27642 <br /> TRANSPORTER COPY <br />