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R-WARD <br /> NON-HAZAHODUS WASTE MANIFEST <br /> FOWASTE TREATMENT AND DISPOSAL FACILITY <br /> INC` JOB ACCEPTANCE NO. <br /> GENERATOR r �« „y,T„ ��- REQUIRED PERSONAS PROTECTIVE EQUIPMEN <br /> THRIFTY OIL COMPANY_ ❑GLOVES ❑GOGGLES [:]RESPIRATOR []HARD HAT <br /> MAILING ADDRESS'- '�v " <br /> ���. `>r�z_� �..�a � � �x'�r ❑TY-VEK [:]OTHER <br /> 200000 LAKEWOOD BLVD. <br /> - ��.� 7 �_ � ;�� - SPECIAL HANDLING PROCEDURES <br /> CITY,STATE,ZIP' '� �— <br /> DOWNEY , yCA 90240 <br /> • PHONE - <br /> 310-923-9876 <br /> CONTACT PERSON <br /> PETER D ' AM1IIC0 � <br /> SIGNl TUBE Q AUTHORIZED AGENT/ TITLE DATE <br /> i <br /> WASTE TYPE RECEIVING FACILITY <br /> f <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> r DISPOSAL El WOOD 9999 SOUTH AUSTIN ROAD <br /> r] CONSTRUCTION SOIL r_1 ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRISTY OIL <br /> 12bO N . 4IL Sri I 'PIAY (209) 982- 1009 FAX <br /> STOCKTFON , CA <br /> NAME ' NOTES TRUCK NUMBER <br /> RICH HAMILTON TRUCKING <br /> ADDRESS <br /> 1330 PAULINE AVE . LOAD 4 35 <br /> CITY, STATE, ZIP <br /> g')EST0 , CA 95359 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 200-579-4100 ❑' ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other // <br /> conditions tmpatr 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 DISPOSE BIO AERATE I STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on IL <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 /> � REMARKS <br /> NON-FRIABLE <br /> • FACILITY TICKET NUMBER _ _ ❑ ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE - V <br /> �}� ( l l j ❑ ASH <br /> tJ" ti L' i ` ` ❑ OTHER <br /> SCHEEYULIN"UST 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 # 2 7 6 AY 5 <br /> TRANSPORTER COPY <br />