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ARD <br /> INUIv_rlALMriUUU0 VVIAO I t IVIJV► 41!`t6-r <br /> PMWWASTE TREATMENT AND DISPOSAL FACILITY <br /> I1VC. JOB ACCEPTANCE N0.Ah <br /> GENERATOR ,- _ _ _r _ _ _ _ REQUIRED PERSONAL PFIOTECTIVE EQUIPMENT <br /> IN R I F T Y__O I L COMPANY- rq_� F]GLOVES ElGOGGLES []RESPIRATOR ❑HARD HAT <br /> MAILING_ADDRESS J , y - n� w % www �� "='�� ❑TY-VEK ❑OTHER <br /> 100000 LAKEWOOD LBVD, <br /> CITY STATE,ZIP„ -M SPECIAL HANDLING PROCEDURES <br /> ' r' '- -" ""- <br /> • DOWNEY, CA 90240 _ <br /> PHONE <br /> 310-923-9876 <br /> CONTACT PERSON <br /> PETER D ' API Ca - - <br /> SIGNATURE OF AUTHO ZED AGENT/ TITLE DATE <br /> I <br /> WASTE TYPq • RECEIVING FACILITY <br /> 1 <br /> f ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • © DISPOSAL SOIL �, ll <br /> ❑ CONSTRUCTION SOIL �.$o /'/ 9999 SOUTH AUSTIN ROAD , <br /> ❑ °THS MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> THRIFTY OIL <br /> 1250 N . 14ILSON 4AY (209) 982- 1009 FAX <br /> STOCKTON , CA <br />. NAME NOTES TRUCK NUMBER <br /> RICH HA 1ILTO1`I TRUCKI'10 <br /> ADDRESS <br /> 1316 PAULINE AVE . LOAD #34 <br /> CITY, STATE, ZIP <br /> IGDESTO , CA 95358 <br /> PHONE . END DUMP BOTTOM DUMP TRANSFER <br /> 209-579-4100 )0 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLATBED VAN DRUMS <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other <br /> conditions impair the safe and effective d}sposal of the waste or if the waste DISPO A ETHOD (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 SIO 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 si OIL <br /> ' condMons are expected to change such that Forward will be able to accept <br /> the waste [] SLUDGE <br /> • REMARKS <br /> ❑ NON-FRIABLE <br /> FACILI`TY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OFA-AUfHORIZFD AGENT DATE <br /> z <br /> ❑ ASH <br /> P//1 <br /> ❑ OTHER <br /> SCHEDULING MUST BE MADE PRt©R 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 # 27664 <br /> s <br /> TRANSPORTER COPY s <br />