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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
Tags
EHD - Public
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FORWARD � NON-HAZARDOUS WASTE MANIFEST <br /> ; <br /> k WASTE TREATMENT AND DISPOSAL FACILITY ; <br /> INCORP`bRATED I <br /> Y JOB ACC6�T NCE N0. <br /> GENERATOR"y`°j' _R)=�UIRED PERSONALr PROTECTNE E�?UIPME -� <br /> Md GLOVES [:]GOGGLES [:]RESPIRATOR ®HARD HAT <br />' 'MA[jNTADDRESS ❑TY-VEK ❑OTHER <br /> 521 Vest PM Shed SPECIAL HANDLING PROCEDURES <br /> CITY STATE;ZIP' <br />' 1*CA 93245 <br /> PHONE <br /> (209)943-2011 _ <br />' CONTACT PERSON— <br /> NSA Sasdall _ _ <br /> SIGNATURE OF AUTH RIZE©AGENT/Tlf!_E - - DATE_ <br /> Ora <br /> RECEIVING FACILITY <br /> i/11AS �TYPE <br /> _ - <br /> a <br />' ❑ SLUDGE <br /> TREATMENTOIL FORWARD INC LANDFILL <br /> • � <br /> DISPOSAL SOIL ❑❑ NON- FRIABLE ASBESTOS <br /> E] CONSTRUCTION SOIL ❑ ASH 9999 SOUTH AUSTIN ROAD <br /> t ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> • GENERATING FACILITY (209) 982-4298 PHONE, <br /> 4U Mo Road LATHMP (209) 982- 1009 FAX <br /> NAME �`� _ '4A C ��f1,C L� TRACTOR LIG # _ _ __TRUCK NUMBER_ <br /> �.-� <br /> ADDRESS_/-31 S' S n O v TRAILER LIC # W � T ,4t, <br /> . <br /> -ADDRESS-/. <br /> CITY,STATE ZI IC' C)► G 3 d d TRAILER LIC # _ <br /> PHONE_ITC EN UMP� _ BOTTOM DUMP _ TRANSFER <br /> ❑ y - ❑ <br /> SIGNATUREOF AUTHORIZED AGENT OR DRIVER DATE! ROL - F(S) FLAT-BED VAN DRUMS _ <br />' El El <br /> FORWARD INC. LANDFILL cue19 YARDS <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 DISPOSAL METHOD (TO BE COMPLETED BY FORWARD) <br />' impairs the safe and effective operation of the Landfill Forward shall use I DISPOSBio 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 LJ <br /> ' conditions are expected to change such that Forward will be able to accept <br /> the waste _ ❑ SLUDGE <br /> t i REMARKS NON-FRIABLE <br /> ASBESTOS <br /> FACILITY' TICKET NUMBER !' ❑ WOOD <br /> SIGNAT& OF THOR�kE PENT DATE _ <br /> ASH <br /> 7 ❑ 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 MANIFEST # C �] `] <br /> Fol(c95„NH)6 06 SALES COPY i <br />
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