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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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NON-HAZARAS .SPECIALRASTE 8(*BESTOS MANIFEST <br /> Itwaste Is asbestos waste,complete Sections L d III and IV. No. 611112 <br /> - R waste Is NOT asbestos waste,complete only Sections 1,II and In. <br /> ARCO STATION #04932 <br /> a. Generator Name: b. Generating Location: <br /> o. Address <br /> POB 5077 d. Address: 16 E. HARDING <br /> BUENA PARK, CA 90622-5077 STOCKTON, CA <br /> e. Phone No.: (925) 299-8891 PAUL SUPPLE I. Phone No.: N/A <br /> N owner of the generating_facility differs from the generator,provide: <br /> g. Owner's Name:ARCO PRODUCTS COMPANY h. Owner's Phone No.:Same as I(a) <br /> fJAJ 0 1 TYPEi. BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> J. Description of Waste: NON–HAZARDOUS SOIL k, Quantity0 lel 0TYPE <br /> O -O uER PLASRAP BAG <br /> Ri <br /> or W <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Pan 261 or LINKS <br /> any applicable state law, has been propedy described, classified an ackaged,and is in proper condition for transportation according toL-YARDS <br /> -POUNDS <br /> applicable regulations:AND,If the waste Is a treatment/res a of reviously restricted hazardous waste subject to the Land Disposal Restrictions,I certify and warant that the wastehas bee ed I a rdance with requiremerrts of 40 CFR Part 268 and is no longer a METERS <br /> hazardous waste as defined by 40 CFR Part 261. ARtSO p YARDS <br /> R <br /> MELISSA KIRN–DII.LARD <br /> Generator Authorized Agent Name Q& Shipment Date <br /> - - Transporter I complete eg - -. <br /> I,52CtIOn II :.,TRANSPORTER <br /> (Generator completaaE,t7rans rterIl com letehn) <br /> TRANSPORTER [ TRANSPORTER II <br /> DILLARD TRUCKING, INC. <br /> a. Name: In. Name: <br /> POB 579 <br /> - b. Address: I. Address: <br /> BYRON, CA 94514 nn <br /> c. Driver Name/I-rtle O A Y—a c2 - J. Driver Name/TItle: - <br /> 925-634-6850 RINTM(PE PRINTn YPE <br /> d. Phone No.: � i Skk NQ.:GU� k. Phone No.: I. Truck No.: <br /> f. Vehicle License No lstais Z,�wo S m.Vehicle License No./State: <br /> Acknowledgement of Receipt of Materials.N Acknowledgement of Receipt of Materials. <br /> n. <br /> ' naNre Shipment Date I Darer S' naWre Shi merR Date <br /> $eCllOn III DESTINATION (Generatorcompietesa-ddestinafionskecompietese-t.) <br /> a. Site Name: BFI – VASCO ROAD SANITARY LANDFILL c. Phone No.: (92.5) 447-0491 <br /> 4001 N. VASCO ROAD 4001 N. VASCO ROAD <br /> b. Physical Address: d. Mailing Address <br /> LIVERMORE, CA 94350 LIVERMORE, CA 94550 <br /> e. Discrepancy Indication Space: <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> rg. �7 <br /> JO-BO 1007-114 <br /> f, / / POO 09-30308 <br />
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