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ARCHIVED REPORTS_XR0002059
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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H
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HAMMER
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1210
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3500 - Local Oversight Program
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PR0545245
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ARCHIVED REPORTS_XR0002059
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Entry Properties
Last modified
1/30/2020 12:09:39 PM
Creation date
1/30/2020 10:56:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002059
RECORD_ID
PR0545245
PE
3528
FACILITY_ID
FA0003730
FACILITY_NAME
TIWANA GAS & FOOD
STREET_NUMBER
1210
Direction
E
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95210
APN
09403012
CURRENT_STATUS
02
SITE_LOCATION
1210 E HAMMER LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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.� TPS Technologies Soil Recycling G i <br /> k an-ifest Nan-Hazardous Sols <br /> Date of Shipment- Responsible for Payment Tra rter Truck# Facility# Given b TPS Load <br /> �/-)_fZL Generator 0 90014 1 <br /> GML.rator s NamL and Billing Addie~ GLnLrator s Phone# Generator s US FPA ID No <br /> ULTRAMAR, IHC. (209) 583-5545 ,Y <br /> 525 WEST THIRD STREET PLrson to Contact <br /> r <br /> TERRANCE FOX <br /> FAX# CustomLr Account NumbLr with TPS ' <br /> HANFORD, CA 93230 US (209) 583-3282 1002367 <br /> Consult-int s NamL and Billing AddrLss Consultants Phone# <br /> HORIZON ENVIRONMENTAL (916) 939-2170 <br /> 5011 GOLDEN FOOTHILL PARKWAY Person oC n Lt <br /> SUITE 7 , <br /> &A1 BARKER <br /> EL DORADO H I LL.S, CA 95'762 US l�Ax# x ,� C[i�[omerAccount Number With Thr - <br /> (916) 939-2172 4HORIZO <br /> Gew-ration SItL(Transport from) (narne f address) o Site Phone# n BTEX <br /> BEACON STATION #1-641 (209) 583-3247 LeVel <br /> 121® EAST HAMMER LANE Person to Contact TPH 'r <br /> i W JERRY UNRUH Levels �t <br /> R y FAX#' AVG <br /> STOCKTON, CA 95210 US (209) 3-3282 Levels <br /> VDesignated Facility(Transport to) (name&address) Facility Phone# Facility Permit Numbers <br /> o` TPS' TECHNOLOGIES INC. (510) 235-8778 <br /> t Person to Contact *� <br /> 20 RECYCLING LANE Cheron s Rice/ Do Murashima ^- <br /> RICHMOND, CA 94801 USA <br /> FAx# (510) '231-4154 <br /> Transporter Name and Mailing Address Transporter s Phone# Transporter s US EPA ID No <br /> s � LUTREL TRUCKING (805) 399-0246 14 <br /> E, SNOW 31,5 r�JNy+� RQAD__ _ r � _ Faison tci CVn[aCt Traribporter y DOT <br /> HERMAN _... <br /> BAKERSFIELD, CA 93308 FAX# Custome4,EU kWerwithTPS <br /> Description of Sod Moisture Content Contaminated by Approx Qty Descrlpbon of Delivery Gross Weight Tare Weight Net Weight <br /> 0-10% ❑ Gas ❑ " <br /> Sand ❑ Organic❑ 10-20% ❑ Diesel ❑ /�v <br /> Clay ❑ Other ❑ 20%-over J Other ❑ `' <br /> m r 14�`�/ !''�(T 4o o} o (ji <br /> Sand ❑ Organic❑ 0-10% ❑ Gas ❑ <br /> Clay ❑ Other © 10-20% ❑ Diesel ❑ <br /> 20'Y-over U Other ❑ cyru <br /> List any exception to items listed above <br /> i <br /> Generator's and/or consultant's certification I/We certify that the soil referenced herein is taken entirely from those soils described in the Soil Data <br /> Sheet completed and certified by melus for the Generation Site shown above and nothing has been added or done to such sod that would alter it in - <br /> any way u <br /> print or Type Name Generator ❑ Consultant ❑ Slg re and date Month Day Year <br /> !� K 06 % <br /> Transpo ter's certification Il We acknowl P receipt of the Boil described aborJo an 'certify Yhat shch soil is betrig delivered to exactly the same t <br /> Ccondition as when received II We further certify that this soiltis being directly transported from the Gener ion Site to the Designated Facility y� <br /> H without off-loading,adding to,subtracting from or in any way delaying delivery to suc i <br /> P"ot or Type N Signa nd date Month D Year <br /> i r' <br /> e <br /> Discrepanci <br /> i31 � <br /> Recycling Facility certifies the receipt of the soil covered by this manifest except as noted above <br /> V Fruit or T <br /> �., ype Name to <br /> Cheron L. Rice/Don S. ,Murashi <br /> Ix <br /> Pkitme print or type ' <br /> s <br /> TPS INVOICING COPY" <br />
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