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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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.i <br /> i <br /> FORWARD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM k <br /> i <br /> Generator: Time Oil Co. <br /> Address: 13475 N., Jack Tone Road <br /> Phone: ( 206)_285 - 2400 ;Contact: Anastasia E. Duarte <br /> a <br /> .w <br /> i <br /> Transporter:__ M%1131ey and Sons Trucking, Inc. ' <br /> Address: 88A6 Elder. Creek Road. Sacramento, CA 95328 <br /> Phone: ( 9i5 ) 381 -86_;Contact: Mr. Tim Manley <br /> I hereby certify that theabove named material was picked up at' the <br /> generator site listed above. <br /> Driver Signaturef—_ <br /> Shipment Date: _•¢ -.Z y <br /> Truck No. : 17-,l _�7r y Load No. _l <br /> Vehicle License No State: - <br /> I <br /> Consultant/Contractor: Canonie Environmental <br /> Address:_ 7y01_5tamerfd-91i7.1, <br /> e D�;jye. Suite 100. Pleasanton. CA <br /> Phone: (415)_463 -_ _9117 _ ;Contact: David Poole <br /> i <br /> I hereby certify that the above named material is- consistent with <br /> the information presented in the Waste Characterization Form and <br /> Contaminated Soil Description Form, and has been properly i <br /> described, classified and packaged, and is in proper condition, for <br /> transport according to applicable regulations. <br /> Name: �' :.rr t.;;-, ��� ,- / .,V.. I c.. L-` Date: March 27, 1992 <br /> Destination: Forward, Inc. <br /> 9999 South Aust'n Road, Manteca, California 95336 <br /> (209) 982-4298 <br /> Received by: is- � <br /> Date: <br /> I <br /> Acceptance No. : 92 -_174 <br /> i <br /> This load contains soil with: <br /> _XXXXXX_ less than 100 ppm. greater than 10U ppm <br /> A COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE <br /> SUBMITTED AT THE GATE FOR ENTRY. ALL LOADS MUST BE SCHEDULED AT <br /> LEAST 24 HOURS IN ADVANCE:- (209) 982-4298 LANDFILL DELIVERIES MUST <br /> BE SCHEDULED ON A DAILY BASIS. . ANY UNSCHEDULED LOADS MAY BE <br /> REFUSED AT THE GATE. <br /> Yards Per this Load:_18 Cubic Yards_ <br /> h <br />
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