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COMPLIANCE INFO PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2705
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2200 - Hazardous Waste Program
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PR0518421
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COMPLIANCE INFO PRE 2019
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Entry Properties
Last modified
6/5/2019 4:25:56 PM
Creation date
6/5/2019 4:08:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0518421
PE
2220
FACILITY_ID
FA0002048
FACILITY_NAME
TESORO (Shell) 68221(WRR 6290)
STREET_NUMBER
2705
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12121008
CURRENT_STATUS
01
SITE_LOCATION
2705 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Please print or tbs.(Form designed refuse on cite(12-pitch) :Nr.) Form Approved.CMS No.205DW39 <br /> UNIFORM HAZARDOUS LGerea:or lD Nnmber 2. aQe Iof 3.Emagenry Response Phone 4.1,13nO leeT�rracckking Nujmw <br /> WASTE MANIFEST �:ARI't00'ikQd 10 ty1Q-J,jssr.,:iiQ$ OBJ2121 r �1 FLE <br /> 5.GennekYs Name end klaliin Whole Genembfs Sm,Address I#oftnt then mmfirg edonm) � <br /> Fftu"13 I Bk:)i O:alStilOi,69721 1 <br /> W.O. Cox RQ-;,C;0 d)05 t;'Dur-Aryclub E;hTi <br /> F?�,n}LQ:�rentah,Saeyatita, Q'A 02101 6,14E-ABU-:3240 9-w,{:!on, 7A 0,5204 <br /> Gen—Phone: <br /> reropapoda 1 LomeanorNim, U.e.EPAID Nurtder <br /> EicL::sFIIHE :�PRrJ1J018:?FJ}:S I <br /> 7.Trarepoda2 Company Name U.S.EPAID Numbef <br /> H ea ' rd ; �,f � .v..r� , All, l'(%sc_��� cr> rrrr' i <br /> Drell Facrily Name end SiiloAddreas U.S.EPAIDNumber i <br /> ❑7rf'AI&rd Ta Kmilwar t <br /> 2 4oN.fltafAPdd't. cornea+rls.',i <br /> U <br /> ,yutun,(-A. 4th 2 <br /> F Phma: S1p-C(37-71Gt1 <br /> So. 9AU.9.00TOeudph'on(mdudm9 Proper SM1gp'ng Name,Harard(Yass,ID Nunber, to.Cmbtnas 11.11.1.1 12.Unit 13 Wasro Codes ' <br /> RM and Padag Graro(danyl) No. Typo Ouanply Wthb1. <br /> I 1' Gasollnzz(A1x1orst, 3, 11\11201, I=V II ) 014 <br /> FDR RECYCLING <br /> FACILITY TY 14 COMPTON,VAQV <br /> J' CALIFORNIA.11-IlS F <br /> PERMITS 10 RFCE'NF YOUR WASTE STREAM <br /> 3352 <br /> F-F-I <br /> 14.Sperm Hardr'og lrsWWem endAdmeenel lnbmaecn yti:,}r'? Al-L AFF`ffJ(�F71ri1" Lit?c1:17'c132fi <br /> F X1(3 1 A rf""RUIVIX-1PIG(-Y:(71}ff;.,. <br /> 02sulln?F„yN tel <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATIONt thereby declare that the contents of this mrelgnnmentare hnymk aWaaroty desoibed above by the proton,ShWng name,old me dassikd,Packaged. <br /> rnaAed aro labeied/pbaided,mM ere b Of nespegsb prcpermMdon laeansportamxding b app9cede'n4melbnal ana nesonalgavemmentel reguroYnns.lf mpon smpment aM I am ea pnmery <br /> Exporter,l cedfy that the contents or He cmnigmeal=turn to the tennsof be attached EPAAdwadedgmentof Censenl. .f <br /> Iady that ltewasbmdnkruaton daMmert MentiFsdn 40 CFR282Y/(a)(dlamalaryanuandrygererala)a(b)(llama sna t(uahtlry generab)!swe. <br /> areata m sP arae '9re a Y , <br /> LM,�:viUO:{2H 1 yf f3L:' l my i,ahalf of g¢7i?r5!Qr \__- / /4 f <br /> S memS <br /> Imnlsal Npnenis <br /> ('� 1 ❑Inpodb U.S. ❑Forged frau U.S. PM dmmy;ex2: <br /> 3 Tansoodw Yme 11tv ox sans : Dataleaa. U.S.: <br /> f 17.7renspoder Admoefedgranta'Receipt dMaterials <br /> p� ❑enspau l Pdnl yped Na. re ro x .art <br /> 0h 67, <br /> Tans r yped Name _... aa! <br /> �L_ �� � l� <br /> IS.Dlsaepancy <br /> lea.Oaaepancy bdladon Space ❑Ouermty ❑Type ❑flesG.ro ❑Pallial Reiaceon ❑k1:RaWon <br /> erondest Refamae Wo,be,.. <br /> 1ab.Altemate Faa'ed(aGOnmeM}` U.S.FPAm Numbs <br /> F spm U <br /> 8 i8c 5ignalwoalAklemam Fad'iry(a Gererakr) k1pMh Day Year <br /> Q l2 <br /> N1g HasanlwsWaele RepMAfakagemant kledpd Ckdes(ee..radar for harardas•,vaslo beabranl daposal,and r¢gdy systema) <br /> 20. synasJ Ff.aa'{7y Q:mera0pealor. 'ation of reafplo/hetardous maleriah rave,ed bylM maryfdsle regi asanted in Item tea <br /> Il drledrFypad.Aamal Sgn lu t Y, Year <br /> 1 ` f -- <br /> EPAForm0?00-22(Rev.305) Previous eddionsare obsolete. DESIGNATED FACILITY TO GENERATOR <br />
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