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ARCHIVED REPORTS XR0000652
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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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r Waste '! <br /> r No ! , <br /> Systems TM <br /> BROWtv1NG-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> 01, 1. <br /> Generator Name Generating Location <br /> Address f r B4,15 Address 312t3 ijc L <br /> 1 0 — <br /> Phone No f Phone No <br /> BFI Waste Code a 0 L= Containers Type <br /> Description of Waste Quantity Units No T pe D- Drum <br /> f C-Cartor <br /> El � I T B- Bag <br /> -%O\ JAZ%RDOL S T -Truck <br /> SOI L ❑ m ❑ P - Pound <br /> Y -Yards <br /> ❑ [�`�� ❑ 4-Other <br /> 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 2601 10 for 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 1s in proper condition for transportation according to applicable regulations <br /> G R U D f M A P 7U .., .�..�_ �- LrlL_;ny. 10 ly I� � Z <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> � �10-fi34-1i850 <br />'truck No tf% Phone No <br /> Dillarc Trucking inc 2 ;i5 e - <br /> Transporter Name Driver Name (Print) <br /> Address r 0 B u\ 218 <br /> Vehicle License No(State <br /> Baron California 91514 <br /> Vehicle Certification l <br /> hereby certify that the above named material was picked up 1 hereby certify that the above named material was delivered witr <br /> at the generator site listed above out incident to the destination listed below <br /> Driver Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name B R I `,'asco Road Landf s l 1 Phone No — t * 7 0 4 9 <br /> 40,01 '�a th �asci �cd Lig ermore Ca 94550 <br /> Address <br /> I hereby certify that the above named material has been acceptednd to the best of my knowledge the foregoing is true and accurate <br /> IN f Authorized Agent Signature <br /> / ece t Date <br /> PASS CODE <br /> 10186 <br /> t3F1260 <br />
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