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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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FORWARDNON-HAZARDOUS WASTE MANIFEST t <br />' I N - y R RATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> id- <br /> Y Lw <br />,� =� - '`•` J08, ACCEPTANCE N0. °$$ ► �, s - - _u <br /> _ `,PROTECTJ]/E EQUIPMENT <br /> BMida <br /> - J�FQUIRED PERSONALS=- -- ---�,.____ .,�'.�.�.-�• <br /> �..�. jC GLOVES ❑GOGGLES [❑RESPIRATOR ®HARD HAT <br />' ILII�GADDDRESS, - `, r __ _ _ _ [:]TY-VEK ❑OTHER <br /> S�1 Ptttne <br /> ZP — A. SPECIAL HANDLING PROCEDURES <br />' - fl4 NE _ <br /> (209)943-2011^ <br />' Q_R'TACT PER ON <br /> N>Idc Bcte�a . <br /> IGI�ATURE AUTHORIZED AGENT TITLE DATE _ <br /> 7k �� lit 2— <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 />' ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY _ _ _ (209) 982-4298 PHONE <br />' "4 Mowdak Rbad LA, nMOP (209) 982- 1009 FAX <br />' AME I ���� TRACTOR LIC # C� TRUCK NUMBER ^ <br /> A14 <br /> DDRESS 1 � �'.�� i - -_ -- - TRAILER LIC # <br /> TY,STATE,ZIP TRAILER LIC # <br /> • PHONE f EN UMP . BOTTOM DUMP TRANSFER y <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL--FF(S) FLAT-BED VAN DRUMS <br /> 7k r,f - fU�a- ❑ El El _❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS _ - <br /> Fgrward shall have no obligation to accept the waste if weather or other <br /> condRions impair the safe and effective disposal of the waste or if the waste D1SP SAL METHOD (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 AERATE 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 will be able to accept <br /> the waste - ❑ SLUDGE <br /> REMARKS <br /> — NON-FRIABLE <br /> ❑ <br /> FACILITY TICKET NUMBER ASBESTOS <br /> ❑ WOOD <br /> SIGNATURE lF AUTHORIZED AGENT t _ DATE <br /> E] ASH <br /> * /' // .�� / G ❑ OTHER <br /> SCHEDULING MUST BE MADE PRIOR Tta 4 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL • ANY UNSCHEDULED LOADS ARE <br /> SUBJECT TO REFUSAL UPON ARRIVAL kNGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TO SCHEDULE CALL (209)982-4298 SALES COPY 720232 <br /> FOi fC9511NH)6 96 MANIFEST # C <br />
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