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ARCHIVED REPORTS_XR0008533
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATERLOO
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4315
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3500 - Local Oversight Program
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PR0545859
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ARCHIVED REPORTS_XR0008533
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Entry Properties
Last modified
6/3/2020 5:14:24 PM
Creation date
8/15/2019 11:59:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008533
RECORD_ID
PR0545859
PE
3528
FACILITY_ID
FA0003831
FACILITY_NAME
WATERLOO FOODMART
STREET_NUMBER
4315
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215-2305
APN
08710034
CURRENT_STATUS
02
SITE_LOCATION
4315 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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of Cq , <br /> A i+roiM.ed#Pratecim Agency <br /> pnnnt p6"�r No 2030}0039(EAp..9 3494) See Instructions on back of page 6 <br /> rYPe Fenn 4" ,od for ew on ehst f 12pitdi)Mpei'n*W Deparli,rrir of Tota Subskeim Cotir W <br /> S I Cardeeea <br /> UNIFORM HAZARDOUS 1 Generator's US EPA ID No Maisdest Document No 2 Pape 1 brfareraboo in Are shaded arrtas <br /> WASTE MANIFESTis not requred by Fedora law <br /> CAD98 1 460033 3 0 9 5 of ' <br /> 3 Gr+e.at x s Name and Moiling Address SMELL OIL COMPANY <br /> HAZARDOUS WASTE DEPT. <br /> D.0. BOX 48+48 <br /> Generator,s Phone (714)5?-0-3312 At`AHE I ill. CA 92803 <br /> on 1 Comp«�r Name 6 US FPA F Numb. <br /> 7 Transporter 2 Company Name 8 US EPA ID Number rT <br /> r ywi " <br /> 9 Designated Facility Name and Site Address 14 US EPA ID Number CsraSlafe s l0 <br /> Efl I C}',s0N, 11-4C. Vjh%,, <br /> ' 255 POPE? PL:'Ti. C A D '; ;� ? � � ?� =, _ H recirnlrs rhor,. <br /> e !- QL a` <br /> I 1 US DOT Dew iption(including Proper Shipping Name Hazard Class and ID Number) 12 Containers 13 Total 14, Unit <br /> a i ti ✓ rtfy] t c t No TYD& Wt/Vos t <br />' Cot7 1 r P ` a~ 0 L 0 _F <br /> b <br /> c <br /> , <br />' d <br /> 'PiPtf� <br /> ran fel Materials Lhmd" <br /> ��'l ^y{yY 1� ^S i'S1 ^'S,Q ~S. .� 3`r�i•' �,l 3�!„�.� � .i� ��' fi <.� r <br /> iFciFu <br /> .,� f+' <br /> I `"t' <br /> 15 l Handl, instructions and Additional Information <br /> FACILITY: <br /> AVOID CONTACT WITH SKIN/EYES SERVICE S7ATION <br /> 24 HOUR EMEACEtjCv rj`n :E NUMBER (8 +0) 424-9:.005 �T3I5 wATERLOO ROAD <br /> ET oCKTO4i. CA. 95205 <br /> 16 GENERATOR 5 CERTIFICATION I hereby declare that the contents of the consign are are fully and ocevratefy described above <br /> packed marked and labeled and are in all r by Proper shipping name and are classified <br /> aspects m proper condition for transport by highway according to applicable federal stole and international Iawt <br /> If I am a large quontrty generator 1 certify that I have a Program m pkat& to reduce the volume and tax,crty of waste generated to the <br /> economucally practicable and that I haw selected the practicable method of treatment storage or di degree t have determined and fo use <br /> threat to human heoM and the environment OR d I am a small ag spa"currently available men t i me whirl, a gen ria the present and future <br /> waste manage tent method that is available to me and that I can affordF haw made a good faith effort to minimize my waste generatan and select the best <br /> kTraasporter <br /> ame Sig to ChE UEJfrn,�r uF neontb <br /> ' Day Year <br /> SNE_L t�sf_ CO.1 Acknowl&d ement of Racer t of Mreeriols me S <br /> Met" '\Day Year <br /> f 8 Tran r 2 Ac wied m�ofRh ofMcter,als <br /> Printed/Typed Name Sigruature <br /> Month Day Year <br /> s <br /> 19 Discrepancy Indication Space <br /> 20 Foch Owner or O rotor Certif�1,. rete, t of hazardous matenars covered b this monifest ext as noted in Item 19 <br /> /Typed Norire Signature <br /> Month Day Year <br /> 3475242804+:i96a JS DO NOT WRITE BELOW THIS LINE <br /> A (12/91) <br /> Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 22 <br /> To P O Box 400 Sacramento CA 95812 0400 <br />
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