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ARCHIVED REPORTS XR0000652
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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B
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BENJAMIN HOLT
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3128
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3500 - Local Oversight Program
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PR0544112
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ARCHIVED REPORTS XR0000652
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Entry Properties
Last modified
2/7/2019 5:25:12 PM
Creation date
2/7/2019 3:35:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000652
RECORD_ID
PR0544112
PE
3528
FACILITY_ID
FA0005145
FACILITY_NAME
EXXON COMPANY USA
STREET_NUMBER
3128
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09523002
CURRENT_STATUS
02
SITE_LOCATION
3128 W BENJAMIN HOLT DR
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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OWaste No 13 <br /> r <br /> SySte�1S TM <br /> BROWNING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> GENERATOR <br /> Generator Name " Generating Location <br /> Address P O Bo% 44'1' Address 3128 k Beniamin dolt l-i* <br /> NOUS[.) TPS-_�, %�,_�J—� i_ ctI fol ilia <br /> Phone No p Phone No �T <br /> BFI Waste Code `� 0 ' ' Containers Type <br /> Description of Waste Duantit Units No 7 pe � ' Drum <br /> T C - Carto <br /> ' F� 1 0 l B - Bag <br /> *;ON HAZARDOUST -Truck <br /> SOIL ❑ m ❑ P - Pouni <br /> Y -Yard, <br /> F1m � O Othei <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations <br /> Ge erator Authorized Agent Name Signatur Shipment Date <br /> TRANSPORTER <br /> 510-6311-680 <br /> Truck No Phone No <br /> Transporter Name Dillard Tiuckin2 Inc 2 5= Driver Name (Pnnt) < <� ` w`yyG,n <br /> Address P O Box 218 Vehicle License No/State � ( �- <br /> Bvron California 94514 <br /> Vehicle Certification `s�! Z <br /> I hereby certify that the above named material was picked up l hereby certify that the above named material was delivered wi <br /> at the generator site listed above out incident to the destination listed below <br /> -2 ��� / / - <br /> Driver Signature Shipment Date river Signature Delivery Date <br /> DESTINATION <br /> Site Name B F I Vasco Road Landf ill Phone No ' 1 3 — 4 7 3 4 r <br /> 4001 North Rd L3,,ermor e Ca `+4550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best y knowledge the foregoing is true and accurat <br /> of Authorized - Signature Receipt DateA PASS CODE <br /> 10186 BF12 i <br />
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