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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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JACK TONE
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13475
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3500 - Local Oversight Program
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PR0545314
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/11/2020 10:29:58 PM
Creation date
2/11/2020 9:42:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545314
PE
3528
FACILITY_ID
FA0005333
FACILITY_NAME
JACKPOT
STREET_NUMBER
13475
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
LODI
Zip
95240
APN
06326004
CURRENT_STATUS
02
SITE_LOCATION
13475 N JACK TONE RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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€ IOJRWARD, INC. NON-HAZAgDOIIB <br /> -'' WASTE DRIVER IDENTIFICATION FORM <br /> Generator: Time <br /> it Co. # <br /> Address: 13475 N Jack Tone Road f <br /> ". <br /> Phone: ( 206) 285�--2400 iContact: Anastasia E Duarte <br /> Transporter: ~� <br /> Address; ru kin Inc. <br /> . ' <br /> Phone: ( 915 ramento CA 958 <br /> _, Contact: 28 <br /> Mr, Tim 28 <br /> I hereby certify that the above named mate <br /> generator site listed above. real was picked up at the <br /> Driver Signature:. <br /> ' Shipment Date: �� Y�► <br /> 'r <br /> rye,. Truck No. : <br /> Vehicle License No. Load No. <br /> /State: � -- [' c• � <br /> Consultant/Contractor: Canonie Environmental <br /> Address: <br /> Phone: (415) 463 _ nton CA <br /> 9117 'Contact: David Poole <br /> , I hereby certify --�_ <br /> the ieby certify that the above named material is consistent w' <br /> Contaminated presented in the Waste Characterization Form acid <br /> Description Form <br /> and has been properly <br /> described, classified and Packaged, and is in proper condition <br /> transport accordinfor <br /> g to applicable regulations. <br /> Name: ./ <br /> Date: March 27 <br /> 1992 •� <br /> Destination: <br /> Forward, Inc. +� <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 : <br /> Received by: , 'N <br /> Date: <br /> Acceptance No. ; g2 _ 174 <br /> — _ — <br /> This Load contains soil with: <br /> I <br /> XXXX <br /> -XX _ less than x00 ppm <br /> A COPY OF --.� greater than loo ppm <br /> THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE t <br /> SUBMITTED TH y.� I <br /> LEAST 24 HOURS GATE FOR ENTRY. ALL LOADS MUST BE SCHEDULED AT <br /> BE SCHEDULERS IN ADVANCE; (2Q9? 98x_{2gg `- <br /> REFUSED ON A DAILY BASIS. ANY UNSCHEDU ED LOADSDFILL I;K,�, MUST <br /> AT THE GATE. <br /> BE <br /> s. <br /> Yards Per this Load:-18•_18 Cubic Yards - <br /> E� <br />
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