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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 LJ Newlay 1614"au rg%r...�...� <br /> Sanitary Landfill Sanitary' Landfill ' Sahltary ti(1hdflll Landfill <br /> 901 Bailey Road 12310 San MAteo Road 1601 Dixon Lanfling Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Ml$taa,OA 9§Cf*, , ` Manteca,CA$5336 <br /> Phone(925)+458-9800 Phone(650)726-1819 Phone(408)90-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2811 Fax(269)982-1009 <br /> NON»H RD0.US WA$TE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING A DRESS _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL.PROTECTUIPMENT <br /> Stocidon. CA 95203 0 GLOVES O GOGGLES a RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 530 66&5300 O TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> nave Thcelfall <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> /� <br /> GEN TOR S CERnFICAMN I hereby certify chat bre above namad llialeda!Is rtot a hazardous <br /> w a as defined by 40 CFR Part 281 or BOe 22 of the Camonda node of mgulaiions has been OMPOV <br /> senbed dasalf€ed and packaged and is fn proper 4ondilion for transportation a to apple" <br /> ragulallons AND,If lire waifs Is a treatment residue of a prwAoaely restricted hssatdous waste <br /> suboct to the Land Dispose!Restrictions I certify and warrard dw the waste has been treated in RECEIVING FACILITY <br /> aocordanee with the nRuiremante of 40 CFR Part 288 and Is no longer a huardous waste as defined by <br /> 40 CFR Part 201 <br /> WASTE TYPE <br /> ❑DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> •DEBRIS OOTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> SODS In lCkitig, I AC <br /> ADDRE <br /> CITY,S , <br /> W$OF Greek Rd <br /> PHONE SaGramemeGA END DUMP BOTTOM DUMP TRANSFER <br /> SIGN_ RIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> `� ❑ ❑ ❑ ❑ <br /> fly-, <br /> � ' <br /> CUBIC YARDS ' <br /> I hereby certify that the above named material has been 18 Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> t ❑ 501.E <br /> REMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> AS$ESTOS <br /> SIGNATURE OFAUgiORIZEDAQENT DATE <br /> O WOOD <br /> 1 . f <br /> 0"A5H , <br /> Q- PECIALOTHER <br /> s, <br /> SCHEDULING MST BE MADE PRIOR TO 3 00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UP N"ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TRANSPORTER COPY Y �_ MANIFEST# <br /> 52894 <br />
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