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ARCHIVED REPORTS XR0006108
EnvironmentalHealth
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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 El forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Salley Road 12310 San Mateo Road , 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone ,CA 5035 00 P inteca,CA 95336 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax <br /> (209)982-4298 <br /> ax(209)382-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE <br /> Inaly tial lei Mr <br /> MAILIN <br /> WASTE ACCEPTANCE NO. <br /> R <br /> CITY STATE ZIP — # 3212 <br /> SWMn, CA 95203 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE v GLOVES ❑GOGGLES 13 RESPIRATOR O HARD HAT <br /> CONTACT PERSON O TY VEK ❑OTHER <br /> Uave 1 hreltallSPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> G BATOR S CEMMATION I hereby tartly that tits above named material is twc a hazard" <br /> Ste as defined by 4p CFR PaA 261 or tNla 22 d die CaHpmla coda d raguiadVa.has been property <br /> -described ctassilied and packaoK and Is in proper oors9tion for tranvw w aroomty to <br /> e9 ab x ANU,If the waste is a Meatment residue of•prevbusy roAdO ed han dous w <br /> amft <br /> subject to the LaM Dapcaai Resfrk kwd I certtly and war and that the waste has been treated in <br /> a CFR Part ZSt��uimmarda of 4p cFR Part 2W and is no bnW a haiardom wash as de&wd yy RECEIVING FACILITY <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION p WOOD <br /> 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE , <br /> GENERATING FACILITY <br /> r <br /> 1876 Country Club Blvd, Stockton, CA 95203 - <br /> TRANSPORTER NOTES, VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley ores ruckln , Inc <br /> ADDRESSQ _ <br /> 8896 Elder Greek Rd 1/7 <br /> CITY, 370 <br /> STATE,ZIP <br /> PHONE <br /> END D P BOTTOM DUMP TRANSFER <br /> SIGNA A ORIZED AGENT OR DRIVER DATE <br /> ROLL-0FF S FLATBED VAN DRUMS <br /> d CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD Is true and accurate. (rQ TE f MPLETED BY LANDFILL) <br /> 11iiDISPOSE OTHER <br /> x <br /> REMARKS -- <br /> OFCONSTRLICTION -' <br /> FACILITY TICKET NUMBER DEBRIS <br /> NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGENT DATE ESTOS <br /> f0 D <br /> ©A <br /> a SOMAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING P7 kILY DELIVERIES MU* BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br />
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