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ARCHIVED REPORTS_XR0004956
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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M
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MOSSDALE
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3500 - Local Oversight Program
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PR0545585
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ARCHIVED REPORTS_XR0004956
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Entry Properties
Last modified
9/16/2020 2:05:33 AM
Creation date
3/19/2020 3:30:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004956
RECORD_ID
PR0545585
PE
3528
FACILITY_ID
FA0000212
FACILITY_NAME
Mossdale Chevron
STREET_NUMBER
444
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
02
SITE_LOCATION
444 W MOSSDALE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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1 (jj) --F, 0RWARD NON-HAZARDOUS WASTE MANIFEST <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> • - t `"�' \.i{JlREiI 7 1�C�IUIf Yl"r r A <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT ; <br /> ❑TY-VEK ❑OTHER <br /> S <br /> SPECIAL HANDLING PROCEDURES <br /> P v <br /> IGNAIUR RIA 7 DATE <br /> • ,WASTE TYPE ,-` <br /> RECEIVING FACILITY <br /> SLUDGE1 <br /> TREATMENT SOIL ElNON-FRIABLEASBESTOS FORWARD INC LANDFILL } <br /> • ❑ DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br /> .. ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> • (209) 982-4298 PHONE i <br /> (209) 982- 1009 FAX <br /> I <br /> �y TRUCK NUMBER <br /> 7-1 <br /> Ir1%���" NOTES — <br /> ADDRESS <br /> . ;STATE,ZIP �t a��.- — .w-- .ti 1 <br /> ENPEIP7"� <br /> RANSFER <br />' PHOS��-- t---a_-- - --- ❑ <br /> SIG._ � OFA - RIZED AGENT OR DRIVER DATA° � ROL ElFF�S�) . ~�F��EDY ��r� DRUMS.� <br /> FORWARD INC. LANDFILL cusic YARDS <br /> Forward shall have no obligation to accepi the waste d weather or other /� <br /> conditions impair the safe and effective disposal of the waste or d the waste DI p L METHOD (TO BE COMPLETED BY I ORWARD) <br />' impairs the safe and effective operation of the Landfill Forward shall use DISPOSE 810 AERATE s=xmLE1 OTHER <br /> reasonable efforts to promptly notify Disposer of its inabil y to accept the - <br /> waste for any reason If Forwards refusal to accept the yfaste is based on ❑ S j <br /> weather or other site conditions Forward shall notify the 131sposer when site <br /> conditions are expected to change such that Forward will $e able to accept E] SLUDGE <br /> the waste <br /> ` REMARKS ---- NON-FRIABLE <br /> _ ❑ ASBESTOS <br /> .FACILITY TICKET NUMBER -- ---�-p- ❑ WOOD <br /> IGNATURE OF AUTHORIZED AGENT-, _ DATE �,,� _:�= <br /> _ . _ -- ❑ ASH <br /> g ` <br /> r✓� �,�' �. f� ❑ OTHER <br /> SCHEDULING MUST BE MADE ORIOR 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 # 091398 <br /> SAI FS DOPY — - - -- <br />
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