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-.t,�■I /r�� - �v�✓rv-r�rrc.r►r;-�uuv� v vrr.�, � ���ruvfr-r=te I <br /> WASTE TREATMENT AND DISPOSAL FACILITY <br /> NVE• JOB ACCEPTANCE NO <br /> , ICMN ID `- <br /> GENERATOR M. REQUIRED EERSONAL PROTECTIVE EQUIPMENT <br /> THRIFTY OIL COMPANY ry [:]GLOVES ❑GOGGLES [:]RESPIRATOR ❑HARD HAT <br /> MAILING ADDRESS "''�- It ' ` a _:; E]TY-VEK []OTHER <br /> 100000 LAKEWOOO BLVD. <br /> CITY,STATE,ZIP--z _— *t �`� ' - - , -,, -SPECIAL HANDLING PROCEDURES <br /> DOWNEY, CA 90240 <br /> PHONE W _ - <br /> 310-923-9876 <br /> CONTACT PERSON <br /> PETER D ` AMIICO <br /> SIGNATU OF U�H RIZED AGENT/ TITLE DATE <br /> ^� <br /> WASTE TYPE r� RECEIVING FACIUfTY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> • ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> TH 'IFTY OIL <br /> 125C N . 11ILSON WAY (209) 982- 1009 FAX <br /> STOCKTON , CA <br /> NAME NOTES TRUCK NUMBER <br /> RICH HAdILTON TRUCKI't1 <br /> ADDRESS <br /> 1336 P4ULINE AVE . LOAD 1 35 <br /> CITY,STATE, ZIP <br /> ,jJDESTO , CA 953513 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 2019-5118--41C0 )m ❑ [] <br /> SIGNATURE OF AUTF�ORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED 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 disposal of the waste or if the wasteDISPOSAL METHOD (TO BE COMPLETED BY FORWARD} <br /> impairs the safe and effective operation of the Landfall Forward shall use <br /> reasonable efforts to promptly notify Disposer of its inability to accept theDISPOSE BIO AERATE SPXKPILE 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 SOIL <br /> ' conditions are expected to change such that Forward-wi4-be able to accept <br /> • the waste ❑ SLUDGE <br /> REMARKS <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> /+ ' ❑ WOOD <br /> SIGNAT}lAE OFJTHORIZEDXGENT r DATE <br /> ❑ ASH s <br /> ' r <br /> ❑ OTHER <br /> MEW <br /> SCHEDULING MUST BE MADE PRLO 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 # 27665 <br /> TRANSPORTER COPY <br />