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3500 - Local Oversight Program
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PR0508502
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SITE HISTORY
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Entry Properties
Last modified
11/6/2018 8:23:15 PM
Creation date
11/6/2018 3:17:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE HISTORY
RECORD_ID
PR0508502
PE
3526
FACILITY_ID
FA0008117
FACILITY_NAME
ARCO STATION #4932
STREET_NUMBER
16
Direction
E
STREET_NAME
HARDING
STREET_TYPE
WAY
City
STOCKTON
Zip
95204
APN
13902001
CURRENT_STATUS
01
SITE_LOCATION
16 E HARDING WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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Tags
EHD - Public
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a" <br /> NON-HAZAR666 SPECIAL'-;WASTE &6ASTOS MANIFEST <br /> If waste is asbestos Vesta,complete.Sections I,R;m endlV. N�. 611111 s.. <br /> ff waste 6 hLO,T asbestos waste,complete only Sections I,II and Ill. <br /> Generator Name: <br /> ARCO PRODUCTS COMPANY b. Generating Location: <br /> ARCO STATION #04932 <br /> Address .POB 5077d. Address: 16 E. HARDING <br /> BUENA PARK, CA 90622-5077 STOCKTON, CA <br /> Phone No.: (925) 299-8891 PAUL SUPPLE f. Phone No.: N/A <br /> owner of the generating facility differs from the generator,provide: <br /> Owner's Name:ARCO PRODUCTS COMPANY h. Owner's Phone No.: Same as I(e) <br /> TYPE <br /> BFI WASTE CODE A 0 1 0 1 0DM-METAL DRUM <br /> FT 0 Containers DP -PLASTIC DRUM <br /> NON—HAZARDOUS SOIL B -BAG <br /> Description of Waste: k. Quan' unks0 No. TYPE I -I MIL PLASTIC 0or <br /> ElO _OTHER WRAP BAG <br /> TRUCK <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law, has been properly described. classed and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations;AND,It the waste is a treatment due a previously restricted hazardous waste subject to the land Disposal y -YARDS <br /> Restrictions,I certify and warrant that the waste has at In'accordance 'h e requirements of 40 CFR Part 266 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. I t e it 3 f ARCO PRODUCTS COMPANY Ys -OTHER CUBIC YARDS <br /> / I �/� - <br /> MELISSA KIRK—DILLARD I j/ .i� O <br /> Generator Authorized Agent Name u - Shipment Date <br /> - - ` Transporter t tnpiete <br /> {Generatorcompletea-c;:Trans rterIIcom <br /> TRANSPORTERI TRANSPORTER <br /> DILLARD TRUCKING, INC. <br /> Name: h. Name: <br /> POB 579 <br /> Address: i. Address: <br /> BYRON, CA 94514 <br /> Driver Namerritle: r /C (. Driver Namelritle: - -- <br /> 92 — 4-6850PRINT rYPE PRINTAYPE <br /> Phone No.: e. Truck No.: k. Phone No.: I. Truck No.: <br /> Vehicle License No./State: �.�1 y/7L m.Vehicle License No./State: <br /> AD owl dgement of Receipt f Materials. Acknowledgement of Receipt of Materials. <br /> Z Z n <br /> Dr'er Si nature Shi ment Date I Driver Si nature Shi ment Date <br /> rOCtlO(I,III ,,.; - .:-bESTINATION (Generator completes a-d,destination site completes 0.) <br /> BFI — VASCO ROAD SANITARY LANDFILL (925) 447-0491 <br /> Site Name: c. Phone No.: <br /> Physical Address: <br /> 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD <br /> LIVERMORE, CA 94550 LIVERIVVIORE, CA 94550 <br /> Discrepancy Indication Space: <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> SOB# 1007-114 <br /> 99 i PO# 09-30308 <br />
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