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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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D
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DR MARTIN LUTHER KING JR
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2101
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2200 - Hazardous Waste Program
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PR0523891
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COMPLIANCE INFO
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Entry Properties
Last modified
12/5/2018 10:44:08 AM
Creation date
10/31/2018 3:34:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0523891
PE
2220
FACILITY_ID
FA0014723
FACILITY_NAME
White Hawk, Inc.
STREET_NUMBER
2101
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95205
APN
15514003
CURRENT_STATUS
01
SITE_LOCATION
2101 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\D\DR MARTIN LUTHER KING JR\2101\PR0523891\COMPLIANCE INFO 2005 - 2013.PDF
QuestysFileName
COMPLIANCE INFO 2005 - 2013
QuestysRecordDate
7/12/2017 10:14:19 PM
QuestysRecordID
3499760
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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—_ <br /> L:.nlbt � I .:_ E <br /> ANIFEST <br /> rouN•HAURD�us � r I � r <br /> t WASTE M ' .p ' <br /> v Generator's Nameand MailirgAdd;<s� P otor,.itrAiares„n dieeentriar me krp addr <br /> i <br /> 1 <br /> a i {venerators Phone `. <br /> 6.l'ransporter t Company Name U.S.EPA ID Number <br /> ff 1 <br /> 7.Transporter2 Company Name 1 LS EPA ID Numbor <br /> 1 <br /> 8.Designated Facility Name and Site Address if t A p 1- U.S.EPA IU Number <br /> 7�5w iR1Y F+.1 crx <br /> i16 Facildy's Phone: <br /> 9a 91p U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers I 11.Total 12.Unit <br /> HM and Packing Group(if any)) No Type Quantity WI/Val. <br /> L <br /> 2 2. <br /> W <br /> f'J <br /> 3. <br /> 4. <br /> 13.Special Handling Instructions and Additional intonation <br /> FfACTHI )ttd(>4?1t6L(}i,ef*`[:iT�1C-#Sf$d1`t"y` <br /> 14. GENERATOR'S CERTIFICATION: I codify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Generator's/OHeror'sPrintedRyped Name _ - Signature f Month Day Year <br /> J t 6.International Shipments <br /> F-- ❑Impod to U.S. ❑Expert from U.S. Port of entry/exit <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 16.Transporter Acknowledgment of Receipt of Materials <br /> Transporter l PolardlTyped Name y Signature ' $ Month Day Year <br /> zQ TransporterRPrinted/Typed Name Signature Month .x Day tEaf <br /> C <br /> i'/.Discrepancy <br /> 17z.Discrepancy Indication.Space <br /> 1 ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑FW Rejection <br /> s Manifest Reference Number <br /> � 171h.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ua. facility's Phone: <br /> 17c:Signature ofAdernate Facility(or Generator) Month Day Year <br /> r_ <br /> Z <br /> C7 <br /> w <br /> w <br /> O <br /> 18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a <br /> Pdnted/Typed Name Signature Month Day Year <br /> 6-NHN,-GC-11 <br /> 6-GENERATOR'S IN!T fAL COPY <br />
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