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ARCHIVED REPORTS XR0006810
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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EAST
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2360
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3500 - Local Oversight Program
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PR0544639
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ARCHIVED REPORTS XR0006810
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Entry Properties
Last modified
7/9/2019 5:07:40 PM
Creation date
7/9/2019 3:23:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006810
RECORD_ID
PR0544639
PE
3528
FACILITY_ID
FA0005076
FACILITY_NAME
DICKS EXXON
STREET_NUMBER
2360
STREET_NAME
EAST
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23346001
CURRENT_STATUS
02
SITE_LOCATION
2360 EAST ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\wng
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EHD - Public
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® Recycled Paper ax !A - r .1 J P. J <br /> a.h.nsG — <br /> FORWARD INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 4 <br /> 02347 <br /> Generator <br /> Address — �__ vim, a :> r: i� Lwr: <br /> Phone ( Vic),) Contact <br /> Transporter e, <br /> Address <br /> Phone (209 ) - 2=C201 Contact _ e ` '-� C <br /> I hereby certify that the ab named material was picked up at the generator site listed above <br /> Driver Signature <br /> Shipment Date Z 1 " <br /> Truck No 3 D Z _ Load No <br /> Vehicle License No/State 2- G 5 5 ? 6 C lef� <br /> Sultant/Co'ntractor c -� '�f'" �r " r <br /> Address r� C_L� 7tf <br /> Phone ( Contact <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Form <br /> and Contaminated Soil Description Form,and has been properly described,classified and packaged,and is in proper condition <br /> for transport according to applicable regulations <br /> Name Date <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 <br /> Received by - <br /> Date t LA_ <br /> - <br /> Acceptance No - - <br /> This load contains soil with <br /> less than 100 ppm greater than 100 ppm <br /> Fb OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOR <br /> E TRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL.DELIVERIES <br /> MUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load <br /> TRANSPORTER COPY <br />
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