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ARCHIVED REPORTS XR0000659
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CAPITOL
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6421
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2900 - Site Mitigation Program
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PR0522496
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ARCHIVED REPORTS XR0000659
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Entry Properties
Last modified
2/15/2019 9:22:49 PM
Creation date
2/15/2019 3:11:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000659
RECORD_ID
PR0522496
PE
2957
FACILITY_ID
FA0015317
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95245
APN
05532024
CURRENT_STATUS
02
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
WNg
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EHD - Public
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b <br /> Please <br /> fill.dned puse an air-to(12-pttdt)typ r) <br />' NON-HAZARDOUS i Generator s U5 EPA ID No Manifest Doc No 2 Page i <br /> WASTE MANIFEST n a 0001 <br /> 3 Generator's Name and Mailing Address <br /> Cheveron <br />' hwy 12 // lods , ca <br /> 4 Generator's Phone( 209) 467-1006 <br /> 5 Transporter i Company Name 6 US EPA ID' Number A Transporter's Phone.4 thrifty rooter n/a 673-8201 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transportees Phone <br />' 9 Designated Facility Name and Site Address 10 US EPA 10 Number C Facility s Phone <br /> znviro tec n/a 434-0211 <br /> 2480 athens ave . <br /> lincoin, ca <br />' 13 14 <br /> 11 Waste Shipping Name and Desenption 12 Containers Total Unit , <br /> 3� _ <br /> No I Type Quantity WWol <br /> a r <br /> non haz waste liquid nos 001 Itt 4400 gal ', <br /> G b <br /> E <br /> I Ji N <br /> E <br /> R <br /> A c <br /> T <br /> O <br /> s R <br /> d <br /> ❑ Additional Descriptions for Materials Listed Above E Handling Codes for Wastes Listed Above <br /> purge water from tank <br /> 15 Special Handling Instructions and Additional Information <br />' ry emg // abco <br /> troy w. 826-3803 <br /> 1 1 <br />' 16 GENERATOR'S CERTIFICATION I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste <br /> Printed/Typed Name Signature Month Day Year <br /> Tsporter i Ac1nowled Tent of Receipt of Materials <br />' Pnn d/Typed Nam" net Month Day Year <br /> �� 7-2 --0 <br /> P <br /> O 18 Transporter 2 Acknowledgement f Receipt of Materials <br />' T Printed/Typed Name Signature Month Day year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> 1F <br /> A <br /> C <br /> 20 Facility Owner or Operator Certification of receipt of waste materials covered by this manifest except as noted in Item 19 <br />' Y Pnnted/Typed Name Stgn Month Day Year <br /> P' <br /> BILL ATRAMNEKO <br /> Pnnted by J 3 KELLER&ASSOCIATES INC 12-BLS-05 Rev 12198 <br />` Neenah W1549570368 ORIGINAL- RETURN TO GENERATOR <br /> 4 <br />
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