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ARCHIVED REPORTS XR0003332
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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D
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DA VINCI
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4627
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2900 - Site Mitigation Program
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PR0543804
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ARCHIVED REPORTS XR0003332
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Entry Properties
Last modified
6/28/2019 3:48:01 PM
Creation date
6/28/2019 2:39:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003332
RECORD_ID
PR0543804
PE
2950
FACILITY_ID
FA0024907
FACILITY_NAME
7-ELEVEN STORE #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
QC Status
Approved
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Tags
EHD - Public
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40 PAX <br /> OU <br /> U1"Ub- 6 U4 JvM to <br /> rNvM ire lzLMMULw;lz: lilt, 1V Drjoi rUUJ/ UUJ <br /> TPS Technologies Soil Recycling <br /> Non-Hazardaus Soils <br /> 4 Date of Shtplment. Respnnuble for Payment Transporter Truck N Far.dity a Given by TPS Load 0 <br /> /97 EELMIM 101c) 1 <br /> Generator s Nae and gtidd sal�lat ion Gltltrirt[1r:Phone N I efu raror s U5 EPA iia Nu <br /> 19033NW. Valley Highway W-104 Per%on to contat't <br /> Lent. TA 98032 <br /> rAx# Cuok-)mer Account Nuntbet with TI'S <br /> 0 Consultarnt s Name end Billing Addre%s ConSUltant s Mime N <br /> r� <br /> tim <br /> 1'rrr+in to f`11711AC[ <br /> 1• <br /> Y�? {'rex# C u.tomtr Account Munbrr with TM <br /> ' Generahun Site(T'ra"&port from) (nnrrrc tr a(cJress) ('pont at ©rEX <br /> .g t e• 2x,632 P►rsan to Contact TPH <br /> �' • �. 4627 Da Vinci Drive Levels <br /> Stockton, G PAXaF AVG <br /> G <br /> .►` � r]nlgnattd FnJl�l (Ttvnaport ka (earns&nrfdni,.) Facile !'him i< hnt�lli ty Pertnit Numbers <br /> TPS 'Feclano�l o8 lea. Inc W 62-8001 <br /> 12328 Hibiscus Ave. f croon to Contact <br /> �t Adelanto, CA 92301 Darren Bartlett <br /> e FAX# <br /> sir Transporter Norne and Maihng Addtesis Tr,ns ter's MUMW th Transporter'►U'+EI'A ID No <br /> 14-450-1010 <br /> Plrsbll to Contact Transportcr's WT No <br /> 25422 Trabuco Rd. 0105-269 Larry Moothart <br /> +� El Toro, CA 92630 FAU Custtmurr Account Number with TPS <br /> 13.19.19.I.05606.02 <br /> ' Description of Soil Moisture Cment Contaminated by Approx Qty Description of Delivery GrOSS Weight Tan WIW Net Weight <br /> Sind 1SOtisanie❑ U-10% 0 Gia O <br /> Clay C tltt+er :t 10-'m U Diesel Q `t Ve 4 j W� �3J U <br /> s 2M-aver O Other O I y '/o" <br /> pane Li ovank oo•10'K a Gas D <br /> 10-xn+e a 17iael a I `1 <br /> Clay ti Other D 2n%.-over u Other O <br /> Lid any eKception to iterm lister!Mawr <br /> Genrrutvr n ardIar Lortsultanf s certffl at(on I/Wc cert*that the soil referenced herein a taken entirely from thnKe,mils described in the Soft Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothing has leen added one to such soil that umuld alter it in <br /> any way <br /> Pratt or Type Name Catcraktr p Consultant V �dtnaturc and dater frac <br /> Larry 1900tha«rt/SS1 far Soutbland <br /> 73'ansporter's certificahon VWe m*nnuiledge recerpi of the soil described above and certify that such %oil is being dtlttVW en erectly the saint <br /> condition as when received I/We further certify that this soil is bang directly transported f om the Generation Site to the Deiugrtated Facility <br /> without aff-loading,adding to,subtrariing from or in any slay delaying deli to s silo <br /> ryyte Narr�r bi�na red 27Z, <br /> DayTrost t3 7 <br /> e Recycling Factllty cerisftas the receipt of the sort covered by this manifest except as noted abvuc <br /> Print or Typt Nemscc <br /> sran.w ora eau <br /> wee �a�+n rti-v e-nw <br />
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