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UMI VIVAH" �vr it u...� - I.+V V� Y Yl tV 11_ IV1r%I'411 L.0I <br /> �� WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC �. <br /> ` JOB ACCEPTANCFO �M`:� 1 $8 ;� ' ,x ; <br /> y, � <br /> K <br /> GENERATOR RECAIRED PEBSON4 PROTECnVE EQUIPMENT'-±­ Zt <br /> THRIFTY OIL COMPANY _ _ [:]GLOVES ❑GOGGLES ❑RESPIRAT05 [:1 HARD HAT <br /> MAILING ADDRES' Yet " ; 1k' 5ti; ❑TY-VEK ❑OTHER <br /> 100000 LAKEWOOD BLVD. _ <br /> CITY STAT!< �p���� _'' __, '"�a -" '" "" *t SPECIAL HANDLING PROCEDURES <br /> n- -.. <br /> DOWNEYCA�T90240 r <br /> PHONE <br /> 310-923-9876 <br /> CONTACT PERSON "o' <br /> PETER D ' AMICO <br /> SIGNATPRE OF ORIZED AGENT /TITLE DATE- <br /> * <br /> ATE <br /> * , <br /> 1///1 <br /> WASTE TYPE oei RECEIVING FACILITY <br /> 1 <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 <br /> 1250 N . �11LS'JN 1,4AY (209) 982- 1009 FAX <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> RICH HAt4ILTON TRUCKING <br /> ADDRESSj� <br /> 1335 PAULINE AVE . LOAD 44LS <br /> • CITY, STATE ZIP <br /> • MODESTO , CA 95258 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209--578-4100 ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> 40FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other J <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 DISPOSE 810 AERATE STOCKPILE OTHER <br /> waste for any reason If Forward s refusal to accept the waste is based on <br /> weather or other site conditions Forward shall notify the Disposer when site SOIL <br /> conditions are expected to change such that Forward will be able to acce <br /> • <br /> the waste [] SLUDGE <br /> REMARKS <br /> • - - - � '' NON-FRIABLE <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER _ <br /> _ ❑ WOOD <br /> SIGNATUREOF'AGTHOR ZED AGENT DATE <br /> iJ ❑ 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 DRAY BEFORE <br /> TO SCHEDULE CALL(209) 982-4298 MANIFEST # 27648 <br /> TRANSPORTER COPY <br />