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vvt v i tr ni ts�v�Iu v vrtJ Y G IVI/'ll�ll F I <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> INC. JdB,ACCEPTAMCE N0. , CMM <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> THRIFTY OIL,�COMP N,Y _ __�, ,;,_ _,r- � _ __ ❑GLOVES []GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> MMLING ADDRESS i _ � . '*moi ,1r �; _ Y ElTY-VEK ❑OTHER <br /> 200000 LAKEWOODBLIID.�, x° „�, _ __ SPECIAL HANDLING PROCEDURES <br /> CITY,STATE,ZIP <br /> DOWNEY, CA 902.40 - <br /> PHONE <br /> 310-923,,9875 <br /> CONTACT PERSON " <br /> PETtR D -AM CO <br /> SIGNATURE OF AUTH ZED AGENT /TITLE DATE <br /> !9� <br /> WASTE T PE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • 0 DISPOSAL SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> E:1 CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY OIL <br /> 1250 N . 'WILSON ,JAY (209) 982- 1009 FAX <br /> STOCUON , CA <br />. NAME NOTES TRUCK NUMBER <br /> EACH HAMILTON TRUCKING, <br /> ADDRESS <br /> 1336 PAULINE AVE . L;AD # 33 <br /> • CITY,STATE ZIP <br /> • IODESTO , CA 95358 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209-578-4100 U ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) 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 <br /> conditions impair the safe and effective disposal of the waste or if the waste DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br /> impays the safe and effective operation of the Landfdt 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 notsfy 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 /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER <br /> �,� x ❑ WOOD <br /> SIGNOF/FCUTI,�ORIZE AGENT DATE <br /> ASH <br /> "� �' �`_ I �I / ❑ 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 <br /> THE DAY <br /> BEFORE <br /> TO SCHEDULE CALL(209)982-4298 MANIFEST # G7 6 V 3 <br /> TRANSPORTER COPY <br />