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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EL DORADO
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3500 - Local Oversight Program
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PR0544720
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
8/1/2019 9:47:34 AM
Creation date
8/1/2019 9:27:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544720
PE
3528
FACILITY_ID
FA0024188
FACILITY_NAME
ARCO AM/PM
STREET_NUMBER
6009
Direction
N
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95207
APN
08126064
CURRENT_STATUS
02
SITE_LOCATION
6009 N EL DORADO ST
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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Recycled Paper <br /> r <br /> F_ORWpRD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 1 .., 5377 <br /> Generator: /� ✓ � f // `� s�'��y . �% <br /> Address: <br /> I <br /> Phone: (;o } S�l _ ' // S� Contact: 80-4, <br /> Transporter: <br /> .Address: /a7��' C fir"/i�r/ f��.. c „ <br /> Phone: - �/ / Contact: <br /> I hereby certify that the above named material was picked up at the generator site listed above. <br /> Driver Signature: � 1 <br /> Shipment Date: <br /> Truck No.: Load No.: / <br /> Vehicle License No./State: <br /> Consultant/Contractor: %/ ._S ( �' Y;. <br /> Address-. % %'� �� :y <br /> Phone: ( ,?! } yG.3 ;2 41 c Z Contact: - . v �: t- - <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Form ti <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 /> C <br /> Name: Date: " <br /> j <br /> Destination: Forward, Inc. <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 <br /> Received by: s _ <br /> Date: <br /> Acceptance No.: <br /> This load contains soil with: <br /> less than 100 ppm greater than 100 ppm <br /> A COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOR I <br /> ENTRY.ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS 1N ADVANCE: (209)982-4'298. 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 /> W141r;Z_Rpr-ll ITV r:r10V VC1 1 r%W_TQA\ICQrtQTCD l-r%DV Dull[_r_rurD wino nr.oV - <br />
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