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ARCHIVED REPORTS XR0007691
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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EL DORADO
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400
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3500 - Local Oversight Program
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PR0544653
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ARCHIVED REPORTS XR0007691
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Entry Properties
Last modified
7/11/2019 7:07:34 PM
Creation date
7/11/2019 2:46:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007691
RECORD_ID
PR0544653
PE
3528
FACILITY_ID
FA0004695
FACILITY_NAME
BRIDGESTONE/FIRESTONE #3573
STREET_NUMBER
400
Direction
N
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95201
APN
13907009
CURRENT_STATUS
02
SITE_LOCATION
400 N EL DORADO ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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_ T-S aechnologies Soil Recycling I1 vyf <br /> Non-Hazardous Soils <br /> I Date of shipment: Responsible for Payment Trarispotter Truck# Facdity# Given by TPS load* 4; <br /> <,F <br /> J 1 t fi kai~1.2.141Rt: I X41 �ria t .r ] <br /> Generator&blame and lulling Address Generator's Phone# Generator s US LPA JD No �t <br /> 847-981-2403 is <br /> 13R(DC*sT[�]yNF ROAD 01:611A <br /> Person <br /> ��tttoCon tfactAy��Tc,1 <br /> 2550 'S/. GOLF R1.�F' D 01:Lp11A r7I'{.r�il.. N <br /> Rr)UING MCADOWSS, YL 1U)CI(]R FAX#- Customer AccountNumber WidrTPS <br /> Consultant's!Name and Billing Address Consultant's Phone# <br /> 5b2-968 2751 <br /> 01110H ENVIRONMENTAL Pemn to Contact <br /> A450 E:. SpRiNG S f"1tm HARRY IAJ(ArH � <br /> :SUI-M 212 FAX# Customer Account Nwnbcr with TP5 <br /> LONG <br /> Bg C CA aye r <br /> Generation Site(Transport from) hmnre&mUrrss) Site Phone it 9TEX <br /> Levels <br /> : FORMER RlkiDGESTO NE I RRESTONE �. nto ontact TPH <br /> 400 N. EL DORADO STREEf'µw , . ..� • � Levels <br /> SI(XKTO N, CA. g W 02 FAX#h AVC <br /> a Levels <br /> U1 <br /> C <br /> VDesignated facility(Transport to) (name&mfdress) Facihtv Phone!h Facility Pernut Numbers <br /> ° TPS TEGHNOLUG'T�a�`r INC. <br /> Petson to Contact <br /> 12,328 14[HLSCUS AVENUE DARREN BARI LETT <br /> ADUANT0, CA 92301 FAM <br /> 760 246 13004 x <br /> m <br /> Tracie anr+ter Name and &ting Address Traces orter's Phone#- Trmisporter s US EPA ID No <br /> A.Es.I. - a-Tome CA0913J5&16131 <br /> PIRS 269 Person to Contact Transporter s DOT No <br /> 25422- -1 RMU O ROAD #3.05 BRIAN CASS 450647 <br /> LAKF FOREST, CA 92&aO ~ FAX# Customer Account Number witli TPS <br /> 'l8i 1 7-52-47. 9 9 4,W-IJ-77 10001' <br /> Description of Soil Moisture Content Contaminated by Approx Qty Description of Delivery Groes Welght Tare Welght Net Weight t <br /> Saeid a organic❑ 0-10% ❑ Gas Q <br /> C7av U other Q <br /> 10-20% ❑ Diesel O �1 <br /> 20%-over Ct Other 0 <br /> Sand ❑ organte O 0-10% 0 Gas ❑ <br /> Gay 13 Other 1310-20% 0 Diesel Q <br /> 20%-over❑ Odes ❑ <br /> List any excepilon to items itsted alcove / <br /> L7L '1 � <br /> Generator's and/or consultant s certtficahon 1/We certify that the soil referenced herein is taken entirely from those soils described to the Soil Data <br /> Sheet completed and certified by me/us for the Generation Site shown above and nothin has been added or done to such soil that would alter it in <br /> < any way <br /> Pont orTvpeName Generator ❑ Consultant ❑ Signahue d� Menai Day Year <br /> LARRY MOOTHART (I3ES[for GENERATOR) `i <br />' Transporter s certification t/We acknowledge receipt of the soil described above and certify that such soil is being delivered in exactly the same <br /> o condition as when received 1/We further certify that this soil is being direcfN.transported from the Generation Site to the Designated Facility <br /> without off-loading,adding to,subtracting from or in any way delaying deliv to such site ;] <br />' Print type N Signature date Mon Day Year <br /> j1 <br /> Ducrepandes r f <br />( 1L <br /> tt <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> � Print or 7)rpe Nametrue and date <br /> D BAFtTt V= 11). 8MTON <br /> _ _ <br /> FnnfA I S H LLTT 099 6b6 YVA gig 90 I2LAi 00/EZ/90 <br />
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