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� � Ivuly-nr�nuuuo WAJI t MANII-t6I <br /> INC <br /> �' WASTE T 4TMENT AND DISPOSAL FACILITY <br /> JOB ACCFF ANCE NO. 93 — 544 <br /> N ' . GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3Yffi.X=§yNKXW11X Riverside Cet:iebt Company ©GLOVES []GOGGLES ❑RESPIRATOR ©HARD HAT <br /> MAILING ADDRESS ❑TY-VEK []OTHER <br /> P.U. Rox 49.04 <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES: <br /> Diampttd Bar, CA 91765 C.20 <br /> 1� PHONE <br /> (909)6V3-3660 <br /> II n CONTACT PERSON <br /> Jean Kukusza <br /> +� <br /> SIG NA AUT AGENT/TITLE DATE <br /> .. <br /> *, =+ Contractor <br /> 1612- <br /> E.,: <br /> 6Z 3 <br /> WAS ETYPE.;, r .. RECEIVINGFACIUTY <br /> x �� ❑ SLUDGE <br /> Ij ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> JL ❑ DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> `! GENERATING FACILITY - (209) 982-4298 PHONE <br /> Hiverside Cement. Company <br /> 2925 W. 4Iashington St. (209) 982- <br /> 1009 FAX <br /> Stockton, CA <br /> NAME NOTES.-, 7RUC"IlMBER <br /> Jim Thorpe Oil,Inc. <br /> , ADDRESS -- - - 2-2C <br /> P.O. Box 357 �. <br /> 3 CITY,STATE,ZIP <br /> Lodi,, CA. 95241-0357 <br /> PHONE END DUMP .T_. BOTTOM DUMPS ;;TRANSFER, <br /> (209)36,2-617 5 ❑ ❑ <br /> = SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE .ROLL-OFFS) ,-;':_FLAT BEDxVAN � <br /> 13 El 11 <br /> c <br /> i CUBIC YARDS, <br /> c FORWARD INC. LANDFILL <br /> Q Forward shall have no obligation to accept the waste if weather or other 1�� <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 /> n reasonable efforts to promptly notify Disposer of its inability to accept the :x'3 DISPOSE BIQ AERATE 01OCKPIIE,;OTt ER x <br /> waste for any reason. If Forward's refusal to accept the waste is based on <br /> n weather or other site conditions,Forward shall notify 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 /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT :`" DATE <br /> i '� t ❑ ASH <br /> OTHER <br /> tS(.IIr-P11I.If IG MUST nE MADE f1moll 1C? ^a?t+ r."n. -II IF 11AY rITtOR 10 EXPE(:1E11 ARRIVAL ' ANY UNSCHEDULED LOADS ARE <br /> RI It?.Irr:T T(?RI fl ISAI f IP0r4 ARRIt+AI__0PI(',o1N(',OAII Y �,rl_I+�rRIrS muS'r rzf ^C!FF1)t)1_ED WITH THE LANDFILL THE DAY BEFORE. <br /> To SCI IF0ULE GALL (209) 9t1P_A9g8 MANIFEST# 7876 <br /> tnAtisromEft cors <br />