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REMOVAL_2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MUNDY
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12667
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2300 - Underground Storage Tank Program
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PR0544969
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REMOVAL_2019
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Entry Properties
Last modified
1/17/2020 2:44:44 PM
Creation date
1/17/2020 12:08:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2019
RECORD_ID
PR0544969
PE
2361
FACILITY_ID
FA0025573
FACILITY_NAME
FARM PRIVATE PROPERTY RESIDENCE
STREET_NUMBER
12667
STREET_NAME
MUNDY
STREET_TYPE
RD
City
LODI
Zip
95240
CURRENT_STATUS
03
SITE_LOCATION
12667 MUNDY RD
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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SITE SITE TICKET # CELL <br /> FORWARD LANDFILL - - :49 1436228 <br /> WEIGHMASTER <br /> 9999 S AUSTIN RD MANTECA , CA 95336 <br /> CUSTOMER DATE/TIME IN Td DATVTIME OUT <br /> 010634 <br /> JIM THORPE OIL INC . VEHICLE CONTAI — 00 Pm <br /> MARTIN THORPE REFERENCE <br /> LODI , CA 95240 <br /> Contract : 4 20419192 4 4 BILL OF LADING <br /> Generator : SUSAN KRALJ k 6224048 <br /> SCALE IN GROSS WFTGHT 33 , 440 NET TONS 4 . 62 INBOUND <br /> SCALE OUT TARE WEIGHT 24 , 200 NET WEIGHT 9 , 240 INVOICE <br /> CITY, UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> 30 . ( 10 YD Tracking QTY <br /> 4 , 6f to SW-CONT SOIL Origin : LODI 100 °% <br /> 1 . 01ENVIRONMENTAL FEE 1 <br /> 1 , 03 FUEL RECOVERY FEE <br /> RECEIVE ® <br /> JAN 0 3 2020 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/ SERVICES <br /> TENDERED <br /> The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions CHANGE <br /> on the reverse side and that he or she has the authority to sign this document on behalf of the customer. <br /> CHECK# <br /> RS- F042UPR (07/12) SIGNATURE <br /> SITE FORWARD LANDFILL - - SITE Y8 TICKET # 1436228 CELL <br /> 9999 S AUSTIN RD -MANTECA , CA 95336 WEIGHMASTER Estela R . <br /> CUSTOMER 010634 DATEMMEIN 1 / 3 / 20 11 : 48 am DATEITIT gyx20 12 : 00 pm <br /> JIM THORPE OIL INC . <br /> MARTIN THORPE VEHICLE THORPE 1 CONTAINER <br /> LODI , CA 95240 REFERENCE <br /> Contract : 42041919244 <br /> Generator : SUSAN KRALJ BILL OF LADING 6224048 <br /> SCALE IN GROSS WEIGHT 33 , 440 NET TONS 4 . 62 INBOUND <br /> SCALE OUT TARE WEIGHT 24 , 200 NET WEIGHT 91240 INVOICE <br /> CITY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> 30 . 10 YD Tracking QTY <br /> 4 . 5 to SW—CONT SOIL Origin : LODI 100 % <br /> 1 . 0 ENVIRONMENTAL FEE 1 <br /> 1 . 0 FUEL RECOVERY FEE <br /> TENDERED <br /> The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions CHANGE <br /> on the reverse side and that he or she has the authority to sign this document on behalf of the customer. <br /> CHECK# <br /> RS- F042UPR (07/ 12) SIGNATURE <br />
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