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A " vvi v-I tr1Lr%nL.0�JU0 V VM0 Il C IVVivo 001 <br /> WWASTE TREATMENT AND DISPOSAL FACILITY <br /> ' JOB ACCEPTANCE N0. L CHFt —= 1288r > k'; r { <br /> GENERATOR , REQUIRED PERSONAL PROTECTIVE EQUIPMENT - ,-,, r, <br /> THRIFTY OIL 9"A N X COMPANY _ [—]GLOVES ❑GOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS �� 'g, ','�����_�f�71 ❑TY-VEK ❑OTHER <br /> 100000 LAKEWOOD BLVD. <br /> CITY,STATE,ZIP s Y '' ,` SPECIAL HANDLING PROCEDURES <br /> • DOWN90240-:71EY, CA _ <br /> PHONE <br /> 310-923-9876 <br /> CONTACT PERSON ' <br /> PETER D ' AMICO <br /> SIGNATURE OF AUTHORIZED AGENT/ TITLE DATE <br /> * 1% I f ~ — <br /> WASTE TYPE U RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD r <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY OIL 209 982- 1009 FAX <br /> 12-5Q IN . 'WILSON 'AAY <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> ADDRESS! HAMILTON TRUCKING <br /> 2336 PA'ULINE AVE . LOAD 'r 31 <br /> • CITY,STATE;, ZIP <br /> IODEST,7 , CA 953E8 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 299-573=d?R,? ;© 11 El <br /> SIGNATURI= U D AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> ✓ CUBIC YARDS <br /> FORWARD INC, LANDFILL <br /> Forward shall have no obligation to accept the waste if weather or other 's <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 /> reasonab€e 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 ' 1L <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste ❑ SLUDGE <br /> + REMARKS _ <br /> ❑ NOH-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> - SIGI;AT U E OF,,AaHORIZEV AGENT T DAT <br /> / J ❑ ASH <br /> /, <br /> ❑ OTHER � <br /> SCHEDULING MUST BE MADE PRIORTO 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 WITA THE LANDFILL THE DAYBEFORE <br /> TO SCHEDULE CALL (209) 982-4298 MANIFEST # 27661 <br /> TRANSPORTER COPY r <br />