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SITE INFORMATION AND CORRESPONDENCE
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2900 - Site Mitigation Program
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PR0508132
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
10/4/2018 3:04:48 PM
Creation date
10/4/2018 2:49:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0508132
PE
2957
FACILITY_ID
FA0007953
FACILITY_NAME
CHEVRON #9-5775
STREET_NUMBER
301
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04514002
CURRENT_STATUS
01
SITE_LOCATION
301 KETTLEMAN LN
P_DISTRICT
004
QC Status
Approved
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DSedra
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EHD - Public
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IWM, Inc, <br />INTEGRATED WASTESTREAM MANAGEMENT, INC. <br />1945 Concourse Drive, San Jose, CA 95131-1708 <br />PHONE: 408.433.1990 FAX 408.433-9521 <br />CERTIFICATE OF DISPOSAL <br />Generator Name: Chevron Products Company <br />Address: 6111 Bollinger Canyon Road <br />San Ramon, CA 94583 <br />Contact: Stephanie Furgal <br />Phone: 925-543-2349 <br />Facility Name: Chevron Station #9-5775 <br />Address: 301 W Kettleman Lane <br />Lodi, CA <br />Facility Contact: Brett Krehibiel, Arcadis <br />Phone: 916-985-2079 x14 <br />IWM Job #: <br />98558 -DW <br />7 Drum(s) Of <br />Description of Waste: <br />Non -Hazardous <br />Rinsate Water <br />4/2/09 <br />Removal Date: <br />MCK020409-CH <br />Ticket #: <br />Transporter Information <br />Name: IWM, Inc. <br />Address: 950 Ames Avenue <br />Milpitas, CA 95035 <br />Phone: (408) 942-8940 <br />Dis osal Facility Information <br />Name: Chemical Waste Management <br />Address: 35251 Old Skyline Road <br />Kettleman City, CA 93239 <br />Phone: 800-222-2964 <br />IWM, INC. CERTIFIES THAT THE ABOVE LISTED NON -HAZARDOUS WASTE WILL BE <br />TREATED AND DISPOSED AT THE DESIGNATED FACILITY IN ACCORDANCE WITH <br />APPLICABLE FEDERAL, STATE, AND LOCAL REGULATIONS. <br />William T. DeLon <br />Authorized Representative (Print Name and Signature) <br />4/2/09 <br />Date <br />Attachment 1 part Ldoc Revised: 5/4/09 <br />
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