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IVUIV-r1mLf- hUUUJ VVAbI t IVIANIh't5l <br /> WARD # WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC - , <br /> JOB ACCEPTANCE,NO�,�, <br /> GENERATOR s4 - s—`_ - e REQUIRED PERSONAL PROTECTIVE EQUIPMENT- <br /> THRIFTY OIL COMPANY ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> M�ILIN[6'ADDRESS'' " ` �r 'Y ' -'— <br /> i x� w _ +; � � �' ` ❑TY-VEK []OTHER <br /> 100000 LAKEWOOD BLVD . <br /> CITYSTATE,ZIP�r -'� �'' �= ��- s = ""--=a SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, pCA' 90240 <br />' PHONE _ .s <br /> 310-923-9876 <br /> CONTACT PERSON' <br /> PETER D ' AMICO <br /> SIGNATPRE ggAUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE LI) RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • Q DISPOSAL SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ASH , <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THI�TFTY OIL <br /> 1257 N. 4ILSON WAY (209) 982- 1009 FAX <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> PICH HAFIILTON TRUCKING <br /> ADDRESS <br /> 1335 PAULINE AVE . LOAD 424 <br /> - CITY, STATE, ZIP f] 1"A �] i� <br /> 10DI STO , A 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 279-573-4100 © ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-SED VAN DRUMS <br /> l ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> 1 <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 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 STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste :s 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 /> the waste ❑ SLUDGE <br /> REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER A56E5T05 <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH <br /> ❑ OTHER <br /> SCHEOUL1 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 WMTHE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209) 982-4298 <br /> -- MANIFEST # 27654 <br /> TRANSPORTER COPY <br />