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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2210
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4700 - Waste Tire Program
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PR0524575
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COMPLIANCE INFO
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Entry Properties
Last modified
9/24/2019 4:18:23 PM
Creation date
9/23/2019 2:39:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0524575
PE
4740
FACILITY_ID
FA0006298
FACILITY_NAME
DANIELS PROPERTIES
STREET_NUMBER
2210
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12330040
CURRENT_STATUS
02
SITE_LOCATION
2210 W COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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CField
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EHD - Public
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Csllf r la Integrated Wsste Managslmnt Board <br /> (C@ �C®avl prehensive Trip Log'and'R.eceipts 10002 V.O.Box 1259,S.7—to,CA 95812-1259 <br /> E fX AWPL E 1 2 3 Com rehensive Tri Number <br /> awe"Iax�ul9os)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE 3597604 <br /> 'ay Yg.I„p...CA Compr n•N•Tdp Log.M R•N p%—WgnW(.)ngwxt m•1 N•IM—"—p 06.on.1.fool,MII b•oow10•rM coMldMt41,pnprl• ly"Md•.•CM.In ad•rd•„w Rla,M".14 CCR,S•cUAn ' <br /> IMI M••R.,N•n0 Fl 1•m•W br dlx,Iw,m M W bdonn•d on,o,•CIW 18 M 1 wn 1 U,••gwrl•1 M MI•form W I-Wdm•xnd WeDMm—1w,proNdM on MW f-,W ncNpt <br /> .` Vehicle Information Hauler Address <br /> Truck Decal Number [J <br /> n Business Name - <br /> �_4u Address 3� <br /> City,State and Zip <br /> License Plate Number State % „ •,t �/�Q S <br /> © © ®ICJ ®® ® t_J® Carrrrieron L� [�r !� <br /> I ombN urW .ly of p•T17 uMW T•4�.+al N•slam M C•Idomix mel Me inbmugw WRNd.e mma b Wa xnd ooR•p.In•ddidm.I xrW IMI NNIIkxbon d I.infWnugOn mxy—11 In•u•p•,Ww,nvoogm..r d•nlxlW mW WY o1 NW"M Tin=',RxglMlbn fxlnu.n Io PVYk R••Ou,u.Code redbn•1900 an0 m.Y r•.uD In chN p•naltlp up b f 25,000 pW dry. vldAlbr,or xdnlnbtngv •roIW l up Io 15,000 pW vldaW.pW dxy••d.W0ed N Pubic Rmw <br /> 1pu <br /> cod..smon_ (r�lR/J/yyy <br /> Drl ameHnt lUo~ �P�331 0 7 2 4 3 Driver's Signature. Date` <br /> o o � p� o. 1 0• o r o o o tf Wly' o o � C.iRfy G:UM1W <br /> PicCt'upt a'Deilviry' a �� <br /> Hauler Tire Prodram'ID`/' Site Suffix': Facility Telephone Number <br /> IX. DATE <br /> Lu 0 Whole Tire Count Weight In Lbs.. <br /> aao�aaoaoaa <br /> FFacllity Business . <br /> Volume Cubic Yds. 'Weight in Tons Name/Address..,. <br /> Hauler Name City,State and Zip <br /> Do. Stam or Label OK <br /> Hauler Telephone Numbero [:] Address Same as Hauler )n1i1 J <br /> LAWS <br /> THAT UNDER PENALTY OF PERJURY OF THE <br /> (N/ n' LAWS OF THE STATE OF CALIFORNIA TRA''HE J <br /> ..JYFOIIWTIOH.PROVIOFD.A VE IB.TR EAND CORRECT. <br /> •*` 0 0aa Ao LJ.�C.1°J WW.°AJUIRL'111.:UU �r UaJ�y o°l GAL'y C�lYAWPJ <br /> fi 3 5 9 7 6-0 40-pick up � Delivery� � 0 ® MEE�� <br /> Hauler Tire Program ID / Site SuffixFacility Telephone Number <br /> DATE D©� . ©WJ 7 <br /> R-Whole The count 'O,Walght in'Lbs.. <br /> �.. <br /> Fagility•Buslness.. <br /> Volume Cubic Yds a Weight in Tonsi -'NamelAddress <br /> !Hauler Name - i Cityj tAte arrd Zip <br /> 0St or,Lapel OK <br /> HaiilerTeli Hone Number'. a059o ddress Same as Hauler n10„a J <br /> P M/A for: <br /> I. <br /> FY THAT UNDER PENALTY OFFERJURv OF THE ` <br /> /I�D „��/'�. ✓'w Time) LAW S OF TME SLATY OF CALIFORMUI THAT 1NE <br /> r/ �-yA� PGRO�VID�ED ABOVF I AN RR (��(���'�.�. II <br /> Aft <br /> . e 35.97604 -- <br /> o r/�6pa�• IIID{/�I��eI Lag V� p- .C'J.°.1 11IW:AlIEAL•1S/.:UU f U g � p^I' P �CAIRAPS <br /> g moi'5.9 r'V 6""`V4'• oo G,1 PiCk Up � Delivery <br /> a® ©� Facility Telephone Number n <br /> x Hauler Tire Program ID / Site Suffix DATE <br /> r • <br /> ca wa'ff Whole Tire Count ❑Weight In Lbs. <br /> O ' Fa I Busine . ®i]q__Q ��(,( <br /> �r ❑Volume Cubic Yds.[]Weight in Tons. Na _k—"�_(�11 <br /> o Hauler Name ooA _ <br /> Hauler Telephone Number o� ❑ Address Same as Hauler lntrah <br /> O (N JA foT I CERTIFY THAT UNDER PENALTY OF PERJURY OF TME <br /> O 4 O - WholD Tt—) uW8 OF TME STATE OF CALIFORNIATHAT TIE <br /> IMFORW1nOM PR WDED ABOVE 19 TRUE AND CORRE . <br />
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