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,� LR2 1A� NUN-HNLHHUUUS WASTE MANIFEST <br /> uwn Irl j?a WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N4 <br /> GENERATOR REQUIRED PERSONAL PROTECTIV EQUIPMENT i <br /> THRIFTY_ OIL-COMPANY_ t_. .. _; as. _ter ❑GLOVES ❑GOGGLES ❑RESPIRATOR [3 HARD HAT <br /> MAILING ADDRESS,��Jaz 6" �� a �,- - ❑TY-VEK [:]OTHER <br /> 100000 LAKEWI)OD__LBVD. _ __ SPECIAL HANDLING PROCEDURES <br /> CITY STATE ZIP '�. '`r '„' , <br /> • DOWHY, CA _90240 , y �- <br /> - PHONE ' <br /> 310-923-9875 Y <br /> CONTACT PERSON <br /> PETER AXN D' AMICO <br /> SIGN URE OF�AUTHORIZED AGENT / TITLE DATE <br /> WASTE TYPE RECEIVING-FACIUTY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑v DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH - 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> TRIFTY 1250 H . UJILS0114 'JAY (209) 982- 1009 FAX <br /> STOCKTON , I;A <br /> NAME NATES ' TRUCK NUMBER <br /> RICH HAMILTON TRUCKIiJ <br /> ADDRESS 9 6 0 <br /> 1336 PAULINE AVE . LOAD 713 <br /> CITY, STATE, ZIP <br /> '10DFSTO , CA �+424X 35358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2n9-973-4100 ® ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED$Y 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 BIO 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 si _ffSOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS <br /> ' ❑ NON-FRIABLE <br /> FACIUTYY,:7CKET MBgR ASBESTOS <br /> / ❑ WOOD <br /> SI T O AU RIZ AQ NT D <br /> ❑ AS H <br /> / ❑ OTHER <br /> SCHEDULING MUST BE MADE P LQR`TO 400 PM THE DAY PAJOR TO EXPECTED ARRIVAL 0 ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILLTHEDAY BEFORE <br /> TO SCHEDULE CALL(209)982-4298 � MANIFEST # 27643 <br /> 3 <br /> M � <br /> TRANSPORTER COPY _I <br />