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ARCHIVED REPORTS XR0006477
Environmental Health - Public
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EHD Program Facility Records by Street Name
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PACIFIC
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6425
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2900 - Site Mitigation Program
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PR0519189
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ARCHIVED REPORTS XR0006477
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Last modified
8/21/2019 4:54:08 PM
Creation date
8/21/2019 2:57:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006477
RECORD_ID
PR0519189
PE
2950
FACILITY_ID
FA0014347
FACILITY_NAME
CURRENTLY VACANT
STREET_NUMBER
6425
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09741031
CURRENT_STATUS
02
SITE_LOCATION
6425 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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.FORWARD NON-HAZARDOUS WASTE MANIFEST <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE L11 <br /> - - <br /> GENERATOR REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR []HARD HAT <br /> MAI, G AI}DRESS ' - ❑TY-VEK ❑OTHER <br /> {4y <br /> GITY„57ATE;ZIP SPECIAL HANDLING PROCEDURES <br /> - PHONE <br /> - _-_ <br /> i �Itr <br /> CONTACT PERSON <br /> SIGNATURE Or AUTHORIZED AGENT/ TITLE DATE t <br /> +• ,�' a � �.yam"+ <br /> WASTE-TYPE- <br /> RECEIVING <br /> ASTETYPERECEIVING FACILITY <br /> SLUDGE <br /> ❑ TREATMENT SOIL � <br /> ❑ NON-FRIABLE ASBESTOS FORWARD INC. LANDFILL <br /> • ❑ DISPOSAL SOIL ❑ WOOD <br /> ❑ CONSTRUCTION SOIL p ASH 9999 SOUTH AUSTIN ROAD <br /> © OTHER <br /> MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY - (209) 982-4298 PHONE <br /> (209) 982- 1009 FAX <br /> NAME, f p - - - s' , `NOTES- _ a w TRUCK NUMBER <br /> ADDRESS <br /> • <br /> CITYf STATE,ZIP , <br /> PHONE ENDDUMP , <br /> _ BOTTOM DUMP TRANSFER - y <br /> u ❑ p _ .. . <br /> S0W- URE OF AUTHORIZED AGENT ORbRIVI W DATE - j�O _OF (g) __FLAT-BED VAN l DRUMS <br /> �El ❑ Ela ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS <br /> Forward shall have no obligation to accept the waste if weather or other r� 3 <br /> conditions impair the safe and effective disposal of the waste or if the waste <br /> impairs the safe and effective operation of the Landfill Forward shall use DISPOSAL METHOD (TO BE COMPLETED BY FORWARD <br /> reasonable efforts to promptly notify Disposer of its inability to accept the JDISPOSE[_r 610 I AERATFff i kRLI[ r '` <br /> waste for any reason If Forwards refusal to arrept trip ,Aust. �s based on "- - -- _- -- R d <br /> weather or other site conditions Forward shall notify the Disposer when site ❑ SOIL <br /> conditions are expected to change such that Forward will be able to accept <br /> the waste SLUDGE <br /> • 1 EMARKS-� _ - _ �” <br /> ❑ NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> __ ❑ WOOD <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> M ❑ ASH <br /> ❑ 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 CALF. (209) 982-4298 <br /> MANIFEST # 4 � '* � � 0 <br /> Jx <br /> GENERATOR COPY <br />
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