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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
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WNg
Tags
EHD - Public
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Waste No 854322 <br /> SystemsTM <br /> BROWNING-FERRIS INDUSTRIES ES <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> f <br /> E»on CompanL U S 1 E -lop Statlo- �; l -Co <br />�enerator Name Generating Location <br /> Address P 0 Boy, 4415 Address 3128 k Benjamin Holt Di <br /> 1 Houstan Texas 7+310-4415 Stockton Califofnza <br /> 5 i 0 — 2 -� 6 8 7 0 0 <br /> Phone No Phone No <br /> Ll Waste Code ElA 4 0 5 1 0 1 6 1 7 1 9 1 2 1 1 9 1 6 1 7 Containers Type <br /> Description of Waste Quantity Units No Type D Drum <br /> 0 0 0 1 8 I�LJ O Carton <br /> L. J I�LJ B Bag <br /> NON HAZARDOLS T -Truck <br /> SOIL ❑ ❑ P - Pounds <br /> YYards <br /> 1-1 ❑ ❑ 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 /> 4" , <br /> . illJ L`rU� 'i ;LC,.� t (a 2 2 <br /> enerator Authorized Agent Name Signature Shipment Uate <br /> f <br /> J510-634-6850 <br /> Truck No Phone No <br /> transorter Name Dillard Trucking 5Inc / i+lGn� <br /> P Driver Name (PrinE�li� �'ep <br /> Address P 0 Boa 218 <br /> Vehicle License No/State-.2 <br /> I <br /> BA,ron California 93514 <br /> Vehicle Certification _ <br /> hereby certify that the above named material was picked up I hereby certify that the above named material was delivered wsth- <br /> t the generator site listed above out incident to the destination listed below <br /> aver 5 i nature O <br /> 9 Shipment Date Cinvet Signaturd Delivery Date <br /> � f <br /> lite Name B F I Vasco Road Landfill Phone No 5 1 —L 4 4 7 0 4 9 i <br /> 4001 'north Vasco Rd Litermore Ca 94550 <br /> address <br /> hereby certify that the above named material has been <br /> accepted and to the best of my k owted" the foregoing is true and accurate <br /> of Authonzed A ent Ss n t e ceipi a! <br /> PA5S COME <br /> 10186 f BF1260 720 <br /> 1, .1- nL t C x.11 <br />
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