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ARCHIVED REPORTS XR0005571
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COLONY
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1442
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2900 - Site Mitigation Program
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PR0541478
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ARCHIVED REPORTS XR0005571
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Entry Properties
Last modified
8/19/2020 3:34:19 AM
Creation date
10/10/2018 11:21:36 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS XR0005571
FileName_PostFix
XR0005571
RECORD_ID
PR0541478
PE
2950
FACILITY_ID
FA0023778
FACILITY_NAME
CHEVRON STATION #210997
STREET_NUMBER
1442
Direction
W
STREET_NAME
COLONY
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
26102028
CURRENT_STATUS
01
SITE_LOCATION
1442 W COLONY RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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TMorelli
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EHD - Public
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- +� <br /> FORWARD NON-HAZARDOUS WASTE MANIFEST <br /> b INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. F6.4 - 6_8 6 <br /> GENERATOR _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT_ <br /> (,Spm] I;(A -�_-mm-j�•l; - ��__ [ GLOVES 0 GOGGLES ❑RESPIRATOR ❑HARD NAT <br /> M_AIG_ <br /> LI ADDRESS ❑_ -- _ TY-VEK [:]OTHER <br /> -� SPECIAL HANDLING PROCEDURES <br /> CRY STATE? P _ <br /> PHONE <br /> -- -q - z - <br /> CONTACT PERSON <br /> _ - <br /> Vu—.ss. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ,WASTE TYPE _ _ RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • .DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> jQ-EI_50,-J �'`xL '� (209) 982- 1009 FAX <br /> NAME _ _NOTES <br /> ADDRESS <br /> . CITY,STATE,ZIP <br /> PHONE__—_ END DUMP BOTTOM DUMP TRANSFER <br /> �- - - - El ElSIGNATURE OF AUTH �IZED AGENT OR DRIVER DATE--- ROLL-OFFS) FLAT-BED VAN — DRUMS <br /> FORWA INC. LANDFILL CUBIC YARDS 7y <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 waste DISPOS THOD (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 BIO JAERATE STOCKPILE OTHER <br /> waste for any reason If Forwards refusal to accept the waste is based on — SOIL <br /> weather or other site conditions,Forward shall notify the Disposer when site <br /> conditions are expected to change such that Forward well be able to accept <br /> the waste _ _ - ❑ SLUDGE <br /> REMARKS <br /> NON-FRIABLE <br /> _ _ __ _ ---- -- __-- _-- _ _-- _ ❑ ASBESTOS <br /> FACILITY TICKET NUMBER _ __ __ _ <br /> -- — — — — — - ❑ WOOD <br /> SIGNATURE OFA ORIZED AGENT — --- --- DATE - -- - <br /> ---- - -___-...-- ----- - - -- - L] ASH <br /> f� <br /> ❑ 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 THE DAY BEFORE <br /> TO SCHEDULE CALL(209)982-4298 1. 10870,6 <br /> MANIFEST # <br /> Y <br /> GENERATOR COPY <br />
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