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ARCHIVED REPORTS XR0006108
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0006108
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Entry Properties
Last modified
6/21/2019 12:49:02 PM
Creation date
6/21/2019 10:35:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006108
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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❑ Keller Canyon ❑ Ox Mountain p Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfli rd A - Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road I 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE TO WASTE ACCEPTANCE NO. <br /> MAILING E <br /> ` - # 3212 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> taocKton CA 95203 <br /> PHONE 0 GLOVES U GOGGLES 0 RESPIRATOR ❑HARD HAT <br /> 0 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> ave I hirelfallSPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pall 261 or titla 22 of the Cal forrua Code d reguiawmis has been property <br /> descnbad classified and packaged and u to proper conddion for transponabon a-cordvtg to aporcable <br /> regulations AND,It the waste Is a treatment residue or a prw40usty rostrieted hazardous waem <br /> subject to the Land Disposal Restnctwns I Certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no ion9er a hazardous waste as defined try <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL 0 SLUDGE <br /> `I CONSTRUCTION 0 WOOD <br /> �DEBRIS OOTHER <br /> -!SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1 876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley 8r Sons Trucking, Inc G.4 <br /> ADDRESS <br /> 8896 Elder Creek <br /> CITY, STATE,ZIP <br /> r <br /> PHONE ENDIDVMP BOTTOM DUMP TRANSFER <br /> SIGNA F ORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> y-) 3-t93 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL <br /> Is true and accurate. ) <br /> DISPOSE OTHER <br /> REMARKS ❑SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OFAUASBESTOS <br /> 7HORlZED AGENT DATE <br /> U WOOD <br /> t-*A 0 ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 52893 <br />
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