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Ff <br /> WMARD <br /> - IVVl�-nr��rinuvu� VV/-O I IC IVIHINIrCOI- <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JOB ACC6QTANCE,NO. �wc�w::�=�sz�e ��F+•�. ��� <br /> QENERATOR r - <` r` - Y `'"' ;. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> THRIFTY OIL COMPANY ❑GLOVES [-]GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> Y-VMAI_NG ADDRESSOTHER <br /> 100000 LAKEWOOD BLVD. <br /> ELTY,STATE;ZIPrt­ %�,, -W_ `• L^ A � s ,x'ts � SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, CA 90240 <br /> PHONE <br /> H y <br /> 310--923-9876 <br /> CONTACT PERSON <br /> PETER D� AMICO <br /> SIGNATURE OF A THORIZED AGENT/ TITLE DATE f <br /> * �-'W Y�� 0 1///"_'? <br /> • WASTE TYPE 104 RECEIVING FACILITY <br /> 1 ti <br /> w <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ C SOIL - ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY OIL 209) 982- 1009 FAX <br /> 1250 N . `0ILSON 'SAY <br /> STOCKTON , CA <br /> NAME - NOTES TRUCK NUMBER <br /> R ,,�14 HAI'41LT N TRUCKIN3 <br /> ADDR r <br /> 1336 PAULINE AVE. LOAD 4 21, <br /> - CITY, STATE, ZIP <br /> .iOPHONE D ES + J , Cn 9 5,.J W END DUMP BOTTOM DUMP TRANSFER <br /> 21?0-578-4100 0 ❑ ❑ <br /> SIGNATURE OF AUTFfORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligat:on to accept the waste if weather or other 11�1 <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 inabilrty 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 site ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> • <br /> the waste ❑ SLUDGE <br /> REMARKS _ _�_ _ - ' <br /> NON-FRIABLE <br /> n � <br /> FACILITY TICKET NUMBER - <br /> ASBESTOS <br /> ❑ WOOD <br /> LTURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> LoOTHER <br /> 0- <br /> SCRtDUUffG 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 # 27651 <br /> TRANSPORTER COPY <br />