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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0506390
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Last modified
5/6/2019 1:33:42 PM
Creation date
5/6/2019 1:22:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0506390
PE
2950
FACILITY_ID
FA0007389
FACILITY_NAME
MINI STOP
STREET_NUMBER
244
Direction
W
STREET_NAME
HARDING
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
13708014
CURRENT_STATUS
01
SITE_LOCATION
244 W HARDING WAY
P_LOCATION
01
QC Status
Approved
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EHD - Public
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��jip rUKVVAKL), NON!HAZARDOUS WASTE MANIFEST <br /> a{: INC OR P ORA T E IJ WASTE TRE. �1ENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE N0. 771811 Jlff�k�.11 <br /> rZ <br /> GENERATOR ' REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 0 GLOVES Q GOGGLES ❑RESPIRATOR : HARD HAT <br /> MAILING ADDRESS <br /> 69 <br /> �q/� 8 t 7 - ❑TY-VEK BOTHER Ckxowm <br /> k CITY, STATE, ZIP SPECIALS HANDLING PROCEDURES: <br /> c • I3e firiz-D A.94 x 2{) <br /> „�. PHONE <br /> ' (7-01)747-2955 4 �f <br /> CONTACT PERSON , <br /> SIGNATURE OF AUTHORIZE- AGENT)/ TITLE DATE ail <br /> 5 f r f , n <br /> l <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE 11 I <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> DISPOSAL SOIL ❑ WOOD If <br /> ❑ CONSTRUCTION SOIL El ASH 99991'ISOUTH AUSTIN ROAD <br /> ❑ STOCK PILE El OTHER <br /> II <br /> MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITYIj(209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> i. <br /> I NAME TRACTOF�LIC. #1i TRUCK NUMBER <br /> '_.ImL ..: <br /> ADDRESS TRAILER LIC. # , <br /> Etys - <br /> CITY, STATE, ZIP TRAILER iLIC. # a <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Ell ❑ ❑ <br /> SIGNATURE. AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 9 FLAT-BED VAN DRUMS <br /> 4x. f, �r ❑i ❑ ❑ ❑ <br /> •C i r r f � � <br /> CUBIC YARDS <br /> FORWARD INC. LANDFILL <br /> Forward shall have no obligation to accept the waste if weather or other !r <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 <br /> reasonable efforts to promptly notify Disposer of its inability to accept the IDISPOSE BIO AERATE STOCKPILE 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 site ❑ SOIL <br /> ' conditions are expected to change such that Forward wilt be able to accept, F <br /> the waste. ❑ SLUDGE I I <br /> • REMARKS it <br /> NON-FRIABLE E <br /> ❑ ASBESTOS <br /> FACILITY TICKET NUMBER �k ) <br /> ❑ WOOD ) <br /> SIGNATURE 6F AUTHORIZED ACaENT DATE <br /> I j� "� I, '� i" '� � �� ❑ ASH <br /> �'` i I. Ili l� F-1 <br /> r } fOTHER P <br /> � t i <br /> II 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. I <br /> TO SCHEDULE CALL (209)982-4298 <br /> Fol(cs511NH)6-96 SALES COPY MANIFEST # C 7 4 <br />
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