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Environmental Health - Public
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EHD Program Facility Records by Street Name
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HOLLY
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20500
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3500 - Local Oversight Program
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PR0541264
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Last modified
2/3/2020 1:08:18 PM
Creation date
2/3/2020 9:29:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0541264
PE
3528
FACILITY_ID
FA0023641
FACILITY_NAME
FORMER HOLLY SUGAR FACILITY
STREET_NUMBER
20500
STREET_NAME
HOLLY
STREET_TYPE
DR
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
20500 HOLLY DR
P_LOCATION
03
QC Status
Approved
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EHD - Public
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Sanitary landfill Landfill PA tvivuiftalin u ivewoy isiana �11FarwaGv <br /> 901 Bailey Road Sanitary Landfill Sanitary Landfill Landfily�. ._ <br /> y 28972 ;1 Butte Road 12310 San Mateo Road 01 Landing Road 9999 <br /> Pittsburg, CA 94565 Corvallis, eR 97330 Half Mooli Bay, CA 94019 Milpitas.1DixonDi on Landing S.Austii Road <br /> Phone 5)4 458-9800 Phone (541)745-2018 Phone (650) 726-1819 Phone-(408) 945.2800 Phor eC(2=nj a 234288 <br /> Fax(925)45$=9891 Fax {541}745-3826 Fax(650) 726-9163 Fax (408)262-2871 Fax (203) 9) -,82- 9 <br /> 1 NON-HAZARDOUS WASTE.;MANIFEST <br /> GENERATOR _ I <br /> "eJh� Lae. WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP. . <br /> %cVCA9S,,04 REQ1[IRED;M1PE11SONAL PROTECTIVE E��U 1HARDF-IAT <br /> PHONE j CYGLOVES .13 GOGGLES ❑ RESPIRATOR.'I S34,7670 <br /> ]RSC1 TY-VEK CYSAFETY VESTCONTACT PERSON • <br /> ` SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE.. DATE <br /> GENERATOR'S CERTIFICATION:Ihereby ce tify that the above named material is not a hazar2fous f'b <br /> waste as defined by 4D CFR part 261 or title 22 of the Catiromia code of regulations,has been proper;y <br /> described,classified andipackaged,and is in proper Condition for transportation according to applicable <br /> regulations;AND.If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I Certify and warrant that the waste has been treated in <br /> accordance with261 the requirements of 4t)CFA Part 26 nd Is no longer a hazardous waste as d1fined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE <br /> n�SPOSAL ❑SLUDGE <br /> "Q CONSTRUCTION ❑WOOD <br /> 0 DEBRIS ❑OTHER ,, f <br /> ❑SPECIAL WASTE} , 1 <br /> GENERATING FACILITY <br /> til� o @a I Fa re MAs Y <br /> TRANSPORTER <br /> NOTES: ULLICENSE NUMBER TRUCK NUM_BUR <br /> ADDRESS ;. <br /> pjmt mice 90fr 317 --� <br /> CITY, STATE, ZIP" <br /> PHONE END DUMP BOTTOM DUMP n .FS-ER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF S) FLAT-BED VAN RUMS <br /> �._ C�1 <br /> a:.11r>, .:;1wrRI. <br /> s CUBIC YARDS i <br /> r <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the,foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) _ <br /> DISPOSE <br /> 01-H R <br /> REMARKS ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS . <br /> > ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHoFji2Eb AGENT by TE) <br /> T /f t.. ' ❑ WOOD <br /> {7 " Y "❑ ASH <br /> Q SPECIAL OTHER j <br /> S0149DULING MUST BE MADEIr RI RTO 3,; P.M,THE'DAY MOR TO EXPECTED ARR[VAL•ANY UNSCWEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. OI GOINO DAILY DEUVERIES MiJST•BE SCHEDULED 4NITFI THE LANDFILL THE DAY BEFORE. <br /> Rev 11109 INS-lataGENERATOR COPY,' MANIFEST# " ; <' <br />
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