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WORK PLANS FILE 2
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2725
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3500 - Local Oversight Program
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PR0544596
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WORK PLANS FILE 2
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Last modified
6/24/2019 1:25:23 PM
Creation date
6/24/2019 1:15:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
FileName_PostFix
FILE 2
RECORD_ID
PR0544596
PE
3528
FACILITY_ID
FA0002064
FACILITY_NAME
7-ELEVEN INC. STORE #14117
STREET_NUMBER
2725
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
2725 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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NO. 713997 <br /> NONHAZARDOUS WASTE.DATA FORM <br /> BEESI <br /> 248-148 i <br /> Generator a Name eN Malting Address Generator's Site Address Of different than matling address) <br /> '-'ELEVEN,INC. 7-ELEVEN 14117 <br /> P.O.BOX.80741 2726 COUNTRY CLUB MLVID <br /> r ;. <br /> RANCHO SANTA MARGARITA.,CA 02680 STOCKTON,CA 96204 E <br /> Generstofa Phone: 11 lRf3-32f1U <br /> Container.type removed from site: _ Container type transported to receiving facility: <br /> r <br /> CKDntms ❑ Vacuum Truok. ❑ Roll-off Truck ❑ Dump Truok ❑ Drums XM Vacuum Truck ❑ Rolboff Truck ❑ Dump Truck <br /> ❑ Other ❑ Other <br /> quantity' quantity Volume <br /> WASTE DESCRIPTION, NON^HAZARDOU'0i WATER GENERATING PROCESS VVELL P?l RGjNG/0EC't3N%/ATEF'! <br /> IZ-. COMPONENTS OF WASTE PPM % COMPONENTS OR WASTE! PPM % <br /> 111K(ER 43-�(:l(3afit <br /> 3. <br /> ') 2 TPH <br /> 4. <br /> .:Waste Profile PROPERTIES:pH 7 1t? ❑ SOLID a62t LiouiD ❑ SLUDG£ ElSLURRY L3 OTHER <br /> HANDLING INSTRUCTIONS: <br /> I <br /> Generator Pdntaci fyped Name Signature Month Day <br /> Year <br /> Larry.Maathad.of KSI'an behalf of generator <br /> The Generator ceNes that the waste ae described Is 10o%non-hazardous <br /> Transporter t Company Name Phone# <br /> BELSHIRE ' »ctf3p�?S3Qrt. <br /> [an.poiNr t Printed ped Name Signature <br /> Month Day Year <br /> dansporta,Aci n adgment of Receipt of Malerfals(n ansporter2companyNamePhoneM <br /> IETO :.SONS TRUCKINO,INC. 714�I�9r-#BtiS. <br /> Transporter 2Printe"pedNameSlgnayu Month Day rorar <br /> f <br /> Transporter Acknowledgment of necelpt of Matettale <br /> Uasignated Facility Name and Site Address P w <br /> 0 <br /> MEMENNO Fit F2DOON 1Q-5 7^'74U0 <br /> � <br /> moo N.At.AMres.k ST. - <br /> Q t'omp-rON,C'A`.910222 ' <br /> Wr nt pe ams gnature on Day ear ? <br /> VV <br /> Destgnated Facility Owner or Operetor:Codification of receipt of matedata covered by NO dela form. i <br /> iL4i��. <br />
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