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2900 - Site Mitigation Program
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PR0506190
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Last modified
2/1/2019 2:17:26 PM
Creation date
2/1/2019 2:06:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0506190
PE
2953
FACILITY_ID
FA0007262
FACILITY_NAME
FLORSHEIM HOMES
STREET_NUMBER
0
STREET_NAME
AUTUMN CHASE
STREET_TYPE
CIR
City
STOCKTON
Zip
95219
CURRENT_STATUS
02
SITE_LOCATION
AUTUMN CHASE CIR
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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NON-HAZE PDOIJS WASTE MANIFEST } <br /> WAS# TRIS ENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE 140. /_V7I <br /> GENERATOR <br /> I;l REqUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> +� C�rtQtr,e►�-�- �j. GLOVES ❑IGOGGLES [:]RESPIRATOR HARD HAT <br /> MAILING Q DRESS ❑TY-VEK ❑OTHER <br /> Lj7- e f�, <br /> oot- <br /> CITY,STATE,ZIP r 1 SPECIAL HANDLING PROCEDURES: <br /> r <br /> �c PHONE Ij <br /> CONTACPERSON '3 �gg6 <br /> I SIGNATURE OF AUTHORIZED AGENT /TITLE DATE J ^�NEPCC��H <br /> cl WASTE TYPE RECEIVING FACILITY <br /> - i <br /> ❑ SLUDGE t <br /> � ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> p DISPOSAL 504E ❑ WOOD <br /> CONSTRUCTION SOIL El ASH 9999 SOUTH AUSTIN ROAD <br /> II <br /> El OTHER MANTECA, CALIFORNIA 95336 <br /> - Il iF <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> (209) 982-1009 FAX <br /> NAME NOTES: TRUCK NUMBER <br /> r!ADDRESS/ <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 4- l5/6) 3-p(` 660/ ❑I� ❑ -�� <br /> SIGN Ty6f 9� AUTHORIZ D/GENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> F <br /> ElI El El ❑ <br /> CI <br /> /F i <br /> I� <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other <br /> 1) 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 , ,r <br /> reasonable efforts to promptly notify Disposer of its inability to accept the ijl DISPOSE BIO AERATE STCr-KPiLE OTHER <br /> waste for any reason. If Forward's refusal to accept the waste is based on $ <br /> +" weather or other site conditions, Forward shall notify the Disposer when s4e ❑ SOIL <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste. ❑ SLUDGE <br /> REMARKS <br /> 'f ❑ NON-FRIABLE <br /> J. <br /> FACILITY TICKET NUMBER ASBESTOS <br /> _ ❑ WOOD. <br /> P, SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ ASH + <br /> ❑ OTHER p <br /> SCHEDULING MiUST BE MADE PRIOR TO 4:00 PA'. THE DAY PRIOR TO EXPECTED AFiRiV:;L • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPC)': ARRIVAL. ONGOING,DAILY DELIVERIES MUST BE SCHEDULED %VITH THE LANDFILL THE DAY BEFORE. <br /> TO SCHEDULE CALL (20B) 882-4298 MANIFEST# 43766 <br /> i f <br />
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