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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BANTA
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26700
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4700 - Waste Tire Program
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PR0530621
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COMPLIANCE INFO
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Entry Properties
Last modified
1/28/2020 3:55:39 PM
Creation date
4/5/2019 1:31:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0530621
PE
4740
FACILITY_ID
FA0019879
FACILITY_NAME
QUALITY CARRIERS
STREET_NUMBER
26700
Direction
S
STREET_NAME
BANTA
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
25215008
CURRENT_STATUS
02
SITE_LOCATION
26700 S BANTA RD STE C
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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CField
Tags
EHD - Public
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�060 'ON Wdll EI0Z 'Ol '0;a ami! paAI ;3;d <br /> Ivsr r-Ir _wVv-Ga1U_Uw iU r VVVVw:crtwrrru 6" pv/"1 diY�l <br /> yp y CaRfomia Integrated Waste Management Berard <br /> _ d''l omprehensive Trip. Lang and, eceipts 10002 P.O.Box 1258,Sacramento,CA 9SS12-1259 <br /> Comprehensive Trip Number <br /> A 0 7 917 4 <br /> )'0 6)INSTRUCTIONS©fit BACK OF PART 2 D® NOT TAPE. STAPLE OR DUPLICATE <br /> By elan na thl.CA ConlprnhwuNa T rip Lep ane R—IpL M.•tCnur(A)roq—t thy:the Information Provided on thla form W111 bo w tdorod=nftd•ndal,p"prime.ty tmd Vddo xd—L In aeeordonea wRn Tm.,14 CCR,Soadon <br /> 17N1 ei sea.,H a n•Rvoat 4 erode fcr dLUauro of�I•Inlamutlon,dw C1WN8 w91 concoct Urn alan«(a)of tMe form at Iter addrm•zntl ralopnone number Prwldod Pel tole torte err raW pe <br /> Vehicle information <br /> Truck.Decal Number ...... <br /> a 0. a.RE]. <br /> License Plate-Number State <br /> UO El11 [1-:00, <br /> —— -- <br /> i;Cr:.ly undcv Ti:nulrF o!Px:;u�;wr�4'r'r-�_ _. ridM 3tR:P is elurr!ua ieliCfl In ath7111M:]rn.i uSrE Tar hfatealia'1 ei IM1l6•r101 mJ,n�n ma,rra.'n In eUL•Cn31an,Ip'.Or.;.!iev:J:dar:4JI C!(gnah:Y a:'N <br /> ':.]She Tarp.iyl.la:i.ag�w�al':rP,."�r. :� -::, - .. � ,:,..,..yil I,v`r�gyr+:u:In�-=i.7i��lCr IPY.Pl`r..,;!�:Jn Cr.1]nM TilraG.:puNlnrn tK IJ'�$uGp nn NntN�Pn Paf 11 il':.K dl•.F.rrn.'.d m FllJi r�r:y.'.n:.9 <br /> Driver's.Nam_ • .-..._-_ __-•.._,�_.. __ _ _-_ .. ._-._.___ ._�.,__._...._�. <br /> e(print) Driver's Signature Date <br /> a <br /> 4079174 mm Pick p !Delivelry -o 7 <br /> Hauler Tire Program lD I Site Suffix � r Facility Telephone Number <br /> Dr.TE ILL <br /> DOE, EoEOFDn <br /> Lu Whole Tire Coslnt Weight in Lbs. <br /> Pa..: <br /> F F VP [dme Cubic Y s. -]'Weight in Tons <br /> 0 <br /> E:E <br /> (NJA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> WhOle.TlT�a)., LAWS OF THE STATE OF CALtFORNW THAT THE <br /> WPORMATgN PROVIDED ABOVE IS TRUE A.uD CORRECT. <br /> :CO. 4 0 7 99ad <br /> .f l �iG�C Up+ 3�G�1`3�ry' L� L <br /> U .. <br /> Hamer Tire Program+ ID: Sit-- SuIMx F7 Facility Telephone Number <br /> DATE � �J a I <br /> El, <br /> (�i <br /> r Whote`Iire Count l�lefghtin Liss. D. <br /> ay <br /> o Volume Cubic ids:❑Weight in Tons <br /> - <br /> {� >N IA f.r I CERTIFY THAT UNDER PENALTY OF PMJURY OF THE <br /> t` V1rtlOIO i IfOa) OF:THE STATE OF CALIFORNIA T..T THE <br /> '- 1�1b <br /> INFO RMAT10N PROVIDED ABOVE WTRUE AND CORRECT. <br /> r: r I Fri • P <br /> 4079 4 �� A , �, kUpDeli e� � 0000000-o � <br /> .n' Hauler T re Program ID ! Site Suffix Facility Telephone Number <br /> DAT 00 11 <br /> oar <br /> U, Whote:Ttre Count. nVifeigPTt in Lbs, <br /> F1 <br /> m` j ..oro ElYolume.Cubic Yds,❑Weight in Tons <br /> In <br /> C <br /> w <br /> 110 <br /> EE <br /> I M /nlT/sLs <br /> (N/A Por 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> :Whgw <br /> N/ �r LAWS OF THE STATEOF CA1TFOR141A nLAT THE <br /> INFORYATiON PRONGED ABOVE IB TRUE ANO CORRECT. <br /> IGAIGS Xle3 Z00/Z HOVd Wd OD : 90 : 9 ETOZ/OT/ZT .1GA109 XV-4 <br />
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