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ARCHIVED REPORTS XR0003447
EnvironmentalHealth
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COUNTRY CLUB
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2705
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3500 - Local Oversight Program
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PR0544595
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ARCHIVED REPORTS XR0003447
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Entry Properties
Last modified
6/24/2019 12:10:15 PM
Creation date
6/24/2019 11:15:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003447
RECORD_ID
PR0544595
PE
3528
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
02
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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--OwU&SPECIAL-WASTE A 4.38ESTOS MANIFEST <br /> !!weal.is asbestos waste complete Sections l II EEt and FV No. 9 Q 7�`t V <br /> n <br /> If west.Is 4M asbestos waste complete only Sections i II and III <br /> _SOChOn 1 -GENERATOR (osirwo r comptarn all of sector,I) <br /> a Generator Name Exxon company L, S b Generating Location ` .oil ,Z .t I ut t — <br /> n g8 z L ilA lull � <br /> c Address ern,dig + cf Address 2-if - k r,tt i t r i I Tit, <br /> rr l <br /> IlOttaton T1 77,252-4190 to, r,2on � <br /> [71.3! 656-7761 % <br /> e Phone N4 f Phpne No <br /> If owner of the generating facility differs from the generator provide <br /> g Ownees Name Exxon Compant U S N h Owner's Phone No ` <br /> I BFI WASTE CODE ; C rl 1 L FI Q B !11, <br /> Containers DM METAL D U <br /> ,; M <br /> pP PI ASTIC DRUM <br /> Nail Hazarctotta �D11 a BAG <br /> ! Description of Waste T k Ouanti a 8A B MIL,PLASTIC BAG <br /> or WRAP'+ <br /> o OTHER <br /> GENERATORS CERTIFICATION l hereby certify that the above named material isnot a hazardous waste as defined by 40 GFR Part 261 or UN ITS <br /> sny appluxWe state law has been properly deacnbed Chw4+bed and packaged and is m proper condition tar transportation according to P POUNDS <br /> appkabM re"dans AND,N the waste is a treatment residue of a prwlousty,restricted hazardous waste subject to erre Lard Disporal Y YARD$ <br /> Restrictions I certify aro warrant that the waste has been treated in accordance weft the raquuaments of 40 CFR Part 266 and is inti longer a M' CUBIC METERS <br /> hazerdouswaste asdefined by40CFR Pan261 kt the terltlLbt Of �.1��.0 ��.rar}1dn� rJ 5 A Ya -CUBIC YARDS <br /> // O OTHER <br /> w 7 \ r lr / / (� % h <br /> Generator Authorized Agent Nalne tore Shipment Data <br /> Seadort ijiF 17 NSPORTER Isawittar oompiete s-it Tr pOnern ti , <br /> TRANSPORTER! TRANSPORTER II <br /> DiIlaid Trucking Int <br /> a Name h Name <br /> P 0 Do, 218 - - <br /> + b Address r Address <br /> 1iLtJlt C1 .ri:rl�f <br /> Driver Name/Tdle- 4 1 r - ! Driver NameMbe <br /> I iY f] v 3 f=B^S1� PRIMFfYPE ARMTT/PE <br /> I d Phone No a Truck No k Phone No I Truck No <br /> f f Vehicle License NoJState ] '+ / ' I m Vehicle Ucenso NoJState <br /> Acknowledgement of Receipt of MatenafS .r Acknowledgement of Receipt of Materials <br /> Onwr Lara P+Iver Sinflahim 2mzwt Date <br /> rt JEE t DEST3NAMON {rlenaretor completes■d destlnaaort site carnptatea a!) - - - - - <br /> FiF i L i'1?jr o Rd Laisr}P i l l �S a tr i 11'+ ')4 + <br /> a. Site Name c Phone No _ <br /> 4003 Nortil `ast u Tvad 4001 %0L tit ti>1bt a RU til <br /> b Physical Address d Mallrng Address <br /> Ll%ekwore Cl 94G70 Livermore t 345' 0 <br /> a Drscfe)aattcy Indication Space T ^_ <br /> I hereby certty that the above named material has been accepted and to the beat of my knowledge the foregoing is true and accurate <br /> JOBa 2002 illi <br /> f �' Pat 0q-20491 <br /> Nama Of Auarnnaid Mann swawro _ - - - - - - Rsesat Luis <br /> Section ISI ASBESTOS (Generator compieta a d j u operawr comPietes e) <br /> s. Operator's Name. - - - b Operator's Phone No <br /> c Operatoes Address <br /> d SpecW Handling Instructions and additional information — <br /> } OPERATOR'S CIEFIMFICATiON I hereby declare that IAa conlerits of this consignment are fully and accurately described above by proper shipping name and are ctassriled <br /> packed marked and fabefed and are rn all respects to proper comition for transport by highway according to appitcable Memational and government regulations <br /> e Operator's'Name&-FlUg <br /> Pnnrfrype owmi les S'gnarure Date <br /> I Name and Address <br /> Of Responsible Agency <br /> g ❑ FNaNe ❑ Non fnahle ❑ Both %fnable %nonfnaole <br /> l " Operator Went to the Company wMrch owns 18as0a operates Controls or supervises the-facility being denlol6shad or renovated or rhe demotdion or renovation operation or both <br /> REORDER ONLY THROtMGH 8FI I VARCO CONTRACT TRANSPORTER RETAIN <br />
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