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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 ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary LandfillSanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 s 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 1 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Mary Sanchez <br /> MAILING ADDRESS — <br /> 0 321 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE E UIPMENT <br /> 1;tninktan-GA 95203 ❑GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE p TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> Dave Thretfalls <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> G ENEF ATOR S CERTIFICATION I hereby cerufy drat the above named material rs not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the California code of regulatkm has been property <br /> described classified and packaged and is In proper condition for transportation&-cording 10 applicable <br /> regulations AND,it the waste Is a trietmeM nWIdU&of a Pravicusty restrieW hazardous waste <br /> subject 10 the rand Disposal Reston I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Pari 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> * DISPOSAL Q SLUDGE <br /> * CONSTRUCTION O WOOD <br /> a DEBRIS ❑OTHER <br /> 7 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 168 76 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley& Sons Trucking, In c�z �$� c? <br /> ADDRESS <br /> 88Q6 Eldimir Qr",k Rd <br /> CITY, STATE,ZIP <br /> PHONE SacMMento CA 95828 END DU BOTTOM DUMP TRANSFER <br /> 918 3AI-6ARA <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETEUY LANDFILL) <br /> Is true and accurate. <br /> r DISPOSE OTHER <br /> O SOIL <br /> REMARKS ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKETNUM13ER 0 NON-FRIABLE <br /> ASBESTOS <br /> Ad SIGNATURE OF AUTHORIZED AGENT DATE a WOOD <br /> O ASH <br /> 7�C U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M.THE DAY PRIORTO 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# 52898 <br />
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