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ARCHIVED REPORTS_XR0005021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MOFFAT
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983
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2900 - Site Mitigation Program
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PR0507952
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ARCHIVED REPORTS_XR0005021
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Entry Properties
Last modified
9/16/2020 1:15:01 AM
Creation date
3/17/2020 2:01:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005021
RECORD_ID
PR0507952
PE
2950
FACILITY_ID
FA0007846
FACILITY_NAME
OLYMPIAN CFN
STREET_NUMBER
983
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
APN
22115006
CURRENT_STATUS
01
SITE_LOCATION
983 MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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P-ORWARD 0 _ NON—HAZARDOUS WASTE MANIFEST <br /> "+` ,' <br /> INCORPORATED WASTE TREATMENT AND DISPOSAL FACILITY <br /> JOB ACCEPTANCE NO. 745711, "�r; <br /> GENERATOR _ _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Petrolin CS] ©GLOVES ❑GOGGLES ❑RESPIRATOR ©HARD HAT <br /> (LING ADDRESS _ ❑TY-VEK ❑OTHER <br />' 2191;:n y Drive <br /> CITY,STATE,ZIP SPECIAL HANDLING PROCEDURES <br /> : Storra6CA95206 <br /> PHONE <br /> CONTACT PERSON <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> WASTE TYPE RECEIVING FACILITY <br /> ❑ SLUDGE <br /> ❑ TREATMENT SOIL ❑ NON-FRIABLE ASBESTOS FORWARD INC LANDFILL <br /> • ® DISPOSAL SOIL El WOOD 9999 SOUTH AUSTIN ROAD <br /> El CONSTRUCTION SOIL F-1 ASH <br /> ❑ STOCK PILE ❑ OTHER MANTECA, CALIFORNIA 95336 <br /> GENERATING FACILITY (209) 982-4298 PHONE <br /> 232 ',.c`''hxI ''�'�'` �� (209) 982- 1009 FAX <br /> ME TRACTOR LIC # TRUCK NUMBER <br /> ADDRESS TRAILER LIC # <br /> PW Of's-r-e sn:19 <br /> CITY, STATE,ZIP TRAILER LIC am <br /> Ehret; Cla,SJi�ti <br /> PHONE END PUMP BOTTOM DUMP TRANSFER <br /> '92` h� '��3"3 f❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> �' ! ❑ ❑ ❑ ❑ <br /> FORWARD INC. LANDFILL CUBIC YARDS / <br /> Forwa d shall have no obhgal+on to accept the waste if weather or other <br /> conditions impar the safe and eflective disposal of the waste or d the waste p1SA05A�Mf=TROD (TO BE COMPLETED BY FORWARD) <br /> impairs the sate 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 SiOCKPIIE OTHER <br /> waste for any reason If Forwards 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 will be able to accept <br /> the waste ❑ SLUDGE <br /> REMARKS I <br /> _ <br /> ❑NON-FRIABLE <br /> FACILITY TICKET NUMBER ASBESTOS <br /> - <br /> r I E] WOODS1 N TURE OF AUTHORIZED\AGENT _ DATE <br /> � � <br /> E) ASH <br /> �t Q OTHER <br /> CHEDULING 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 W"THE LANDFILL THE DAY BEFORE <br /> SCHEDULE P6: CALL (2Q9] 982-4298 MANIFEST # C 638 %j O $ 8 <br /> F <br /> 1C9s77NH16 p6 GENERATOR DOPY <br />
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