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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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444
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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
Tags
EHD - Public
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�I y w. NON-HAZARDOUS WASTE MANIFEST <br /> FORWARU -' WASTE TREATMENT AND DISPOSAL FACILITY <br /> Vo INCORPORATED <br /> JOB EPTAIVCE N0. <br /> REQUIREDPERSONA)_,P-R—OTECTEVE ECQUIPNIENT_ <br /> ®GLOVES 0 GOGGLES Q RESPIRATOR ®HARD HAT <br />' MAI_LING ADD ESSx `�` _ �»». t a ❑TY-VEK ❑OTHER <br /> S21 Wed Pim Shed SPECIAL HANDLING PROCEDURES <br /> CITYSTATE, ---- <br /> - <br /> PHORE ` <br /> ` (2{!9)943-2011 <br />' CONTA ERSON , - <br /> N=k <br /> .SIG TUR y0 A RIZE 'AGENT J TITLE DATE <br /> + WAS TYPE RECEIVING FACILITY <br /> . _. <br /> ❑ SLUDGE FORWARD INC LANDFILL <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS <br /> • DISPOSAL SOIL ❑ WOOD 9999 SOUTH AUSTIN ROAD <br /> ❑ CONSTRUCTION SOIL ❑ ASH <br />' " ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ (209) 982-4298 PHONE <br /> 4"Mo&"Road LA'CTMOP (209) 982- 1009 FAX <br />' AME- '""�_ '` --~ - - - TRACTOR LIC # _1 -63 <br /> TRUCK NUMBER_ <br /> ADDRESS. ' <br /> TRAILER LIG # <br /> CITY STATE, ZIP - TRAILER LIC <br /> EN UMP BOTTOM DUMP TRANSFER <br /> PHONE _ ��_� -r��� ��J�� � y ❑ ❑_ ... <br /> SIGN- E OF AUTHORI` D AGENT OR DRIVER DATE{ ROLL-0 (S) FLAT-BED VAN DRUMS <br /> - _ - a�'� 1-1 El ❑ El <br />' FORRD INC. LANDFILL CUBIC Y R <br /> Forward shall ha:no obligation to accept the waste if weather or other <br /> con ns 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 DISPgSE BIO AERATE STOCKPILE OTHER <br /> reasonable efforts to promptly notify Disposer of its inability to accept the - <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 /> rr <br /> ' conditions are expected to change such that Forward will be able to accept <br />' -the waste ❑ SLUDGE <br /> ` _REMARKS_ - NON-FRIABLE <br /> ~ ❑ ASBESTOS <br />' FACILITY TICKET NUMBER_ _ - W ry \ ; �' - ❑ WOOD <br /> IGNATURE OF AUTHOµ AGENT _ DRTEi <br /> _ __ - - -- - ❑ AS H <br /> t <br />�, * �� , �' ❑ OTHER <br /> SCHEDULING MUST BE MADE=ISRI O 4 00 P M THEbAY 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 SB5HEDULF_CALL (209) 982-4298 SALES COPY MANIFEST # C 2 <br />
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