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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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1 Waste No f <br /> Systems TM <br /> 3RlNG-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> ' <br /> GENERATOR <br /> Generator Name Generating Location <br /> Address P 0 Baa 4415 Address 3128 it Ben}aniin Hoff DT <br /> tic=�sst�in 4�5 +�^'0 t ,1 Stockton Ca? , folni <br /> Phone No Phone No -ELL-I= <br /> Containers Type <br /> BFI Waste Code D- Drum <br /> Description of Waste Quantlt Units No T pe C -Cartoi <br /> 0 U L 1 3 B - Bag <br /> NON HAZARBOLS T -Truck <br /> SOIL FTI ❑ m ❑ P - Pounc <br /> Y -Yards <br /> Elm F] O Other <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 /> Ga e6 brMAa70 <br /> PL Z L <br /> G for Authorized Agent Name Signatur Shipment Date <br /> TRANSPORTER <br /> 510-634--6850 <br /> Truck No Phone No <br /> Dillard Trucking Inc 2t � <br /> Transporter Name Driver Name (Print} ! �` �� �^ A F'�� <br /> Address P 0 Box 213 Vehicle License No/State <br /> Byron California 94314 <br /> SSC <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wi <br /> at the geperptor sit I ted above out incident to the destination listed below <br /> y � r , <br /> Ag�i E SW2 <br /> Dn r Signature Shipment Date Dnver Signature Delivery Date <br /> DESTINATION <br /> Site Name <br /> B F I 'vasco toad Landfill Phone No a 1 4 U ` 1 <br /> 4001 Nortl, ldSC0 Rd Livermore Ca 94550 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my kryowl de ge the foregoing is true and accura <br /> Name of Authorized Agent Si nature Recd t Date <br /> PASS CODE <br /> 6F12 <br /> 10186 <br /> i <br />
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