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~,oWA <br /> RD INVIN-nrz.Mnuvuo vvho I t MAINIf LJ f <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. r= =1, ";.�a <br /> CMM t '1288 r I r r M �. <br /> GENERATOR p ,'� a,x�: - ._�prix;_;; REQUIRED PERSONAL PROTEC71VE EQUIPMENT--'-- . <br /> THRIFTY_ OIL _COMPANY ❑GLOVES [:]GOGGLES []RESPIRATOR [:]HARD HAT <br /> MAILING ADDRE S§ ti' � ," � � ; ❑TY-VEK ❑OTHER <br /> 200000 LAKEWOOD BLVD . <br /> CITY STATE,ZIP "�° i"" �""` rFR; 4r�` � SPECIAL HANDLING PROCEDURES <br /> • DOWNEY, �CA 9.0240 <br /> PHONE <br /> 310-HSR 923-9876 <br /> CONTACT PERSON <br /> PETER D ' AMICO <br /> SIGNATURE OF AUTHORIZED AGENT / TITLE DATE <br /> c� <br /> •' WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • Q DISPOSAL SOIL ❑ 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION 501E ❑ ASH ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY OIL (209) 982- 1009 FAX <br /> 1250 N . 14ISSC"J ,JAY <br /> STOCKTON , CA <br />. NAME NOTES TRUCK NUMBER <br /> RICH HAMILTON TRUCKING <br /> ADDRESS <br /> 1336 PAULINE AVP . LOAD a ?g <br /> CITY, STATE, ZIP <br /> MODEST) , CA 95359 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 20 =57 a_ ;O El ❑ ❑ <br /> SIGNAAGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall Have no obligation to accept the waste if weather or other Lconditions impair the sate and effective disposal of the waste or Jthe 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 is based on <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 /> FACIUT,Y TICKET NUMBER r —_ ❑ ASBESTOS <br /> ❑ WOOD <br /> SIGI4ATURE P�AUTkORI Ed AGENT DAT_E <br /> �� ❑ ASH <br /> �� ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL •jANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED W7 THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL(209)982-4298 MANIFEST # 27658 <br /> TRANSPORTER COPY <br />