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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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Cold Pratechon Agency <br /> Proved s e2-404 9(E pn.s 9-sa94) See Instructions on back of page b. <br /> -1 type detrgnrd kir.an.bre(12predr)ryp.vvrrsrr Depanmeet of Tea Substances Control <br /> Sawn.tlo,Caifarre <br /> UNIFORM HAZARDOUS I C+erserators US EPA ID No Alaiufest Document No 2 Page i Inforsnotrcw a tote shaded arras <br /> WASTE,MANIFEST r, is not requeed by Fedim law <br /> 3 Generators Narnr r of <br /> oast Mai+etg Address SHELL OIL COMPANY .A_Stab mm+rhet <br /> on <br /> HAZARDOUS WASTE DEPT. <br />' GeP.0. BOX 4848 a srce+>c aee�ar+stw_ I <br /> Generators P.71 <br /> } —7 <br /> w� <br /> s Tran <br /> TY4 <br /> 15RJ b°r 3 C. S*06'rmrpaT!",lD ` <br /> D 7rvgpprhl r <br /> 7 Transporter 2 Corrtparty Name B US EPA ID Number E..Sfota,T <br /> A ID w <br /> F 7ronsparlr�� �? 1 <br /> 9 Deagnated FacilityName and SAa Address <br /> 10 US EPA ID Number G- � <br /> ER I CRSCN;. INC, x ill <br /> 255 Pf31YR 8LVD. 6 3 9 ff_ Feu ' - rile <br /> 1 1 US DOT Description(including Proper Shipping12 Containers 13 Tota! <br /> Name Hamid doss curd+D Number} 14 UreM 'r <br /> Mil4i t.Z7, 's;Hz:)It ,.,.,.F i y y No T Wt/Vol I waste <br /> 11 <br /> Nuen�rr �..a <br /> 1 T O 9 LA P EPA�.S2 <br /> b <br /> Slate, ice+k� <br /> EPA/Odterr� <br /> c <br /> EPA/OffterW <br /> EPA�Otlser <br /> 'ate st' <br /> drttonal Deau/�tpt�ioreys f��ory,JMaterwk Lrss.d Abaw'gM'�,tl.Y �F aetss infest A �.•Y <br /> IFEMM sTA (B ,� [{}� �}a �;. ".r; y f az�v�t'��-� ' K.` 1N <br /> w�r �+I ���Q'!� Y..�'w:` d✓ �1 E J '"5. �wli' <br /> + <br /> ��'�'"�` <br /> 1- <br /> 15 SPec101 Hondhng lnstnrchain and Additional Information <br /> f1i <br /> VOID CONTAC-i FERV7I I Y, <br /> WITH SKiN/ETES SE�tVICI ST✓~TION <br /> HOUR 0"ERGENCY PHONE NUMPER (800) =r315 APTERL20 ROnD <br /> ET'OCf{TOi�l, G�}. 5cQ1�, <br /> 16 GENERATOR'S CEIRTIFICATION I hereby declaretbat the convenes of Nie conugrtmerrt are fusty and accuratedescribed above b <br />' pocked narked and labeled and are in all res Pete m proper Y Preashipping name and are classified <br /> Per condmon for transport by highway according to applicable federal stale and International laws <br /> Ifam a arge quo"generator I cemfy that I hove a program m place to reduce the volume and tax"of waste generated to the degree I have determined to be <br /> economically Practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which mnnmr:es rhe present and future <br /> threat to human health and the ermronnx t OR if I am a small quontrty generator I have made a goad forth effort to mnumise my waste generation and select the host <br /> waste m method that rs available to me and that I can afford <br /> KPwq <br /> led/,T Nameisr ro �N 1 EHA-1 .."" Month Vl�y Yea <br /> L 75 SHELL `,t I L -Q ! <br /> 17 Transporter 1 Ack wfed merit of Receipt of Materials <br /> Pr, Typed SrgrWhrro Month <br /> -'RIC 111"U 1 cis rrrr..v L,• �- / CJDay7 Gi ear <br /> 18 Transe2Ettr 2 Ac ement of Rec,"Of of Materials <br /> Printed/Typed Nome Signature Month Day Year <br /> 19 Discrepancy Indwaton Space <br /> INE20 FoahtvC>wner or O rotor Certification of receipt of haxordous matenals covered by this manifest except as noted in Item 19 <br /> /TYPE No� Signature Month Day Year <br /> 751- 2804+3582 J8 DO NOT WRITE BELOW THIS LINE <br />[A (12/91) Blue GENERATOR SENDS THIS COPY TO DISC WITHIN 30 DAYS <br /> Y2 To P 0 Box AOO Sacramento CA 95812 0400 <br />
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