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ARCHIVED REPORTS_XR0012743
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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K
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KETTLEMAN
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601
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3500 - Local Oversight Program
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PR0545338
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ARCHIVED REPORTS_XR0012743
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Entry Properties
Last modified
4/9/2020 9:06:40 AM
Creation date
2/12/2020 8:31:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012743
RECORD_ID
PR0545338
PE
3528
FACILITY_ID
FA0003803
FACILITY_NAME
KETTLEMAN CHEVRON
STREET_NUMBER
601
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04728006
CURRENT_STATUS
02
SITE_LOCATION
601 E KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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f <br /> Waste No. 401701 <br /> Systems NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> tIRO'NNIPIG•FEFtIIS INDU5IRIC5 <br /> SEMI <br /> 1..,0r•,1(. . Lal tri:! .Ein1Ci <br /> 51rit-k e ti f!1q Generating Location -0,15 <br /> Generator Ilam° — <br /> rilll 1:. Fe'lLirr^1nn f aslr• ---- <br /> Address 1'. R' Box ,1311 Address -- <br /> Lodi. CA <br /> 51!1 �lntea. Cu. 9•1iO3 � ----- <br /> [ Phone No. <br /> Phone No. L <br /> ConlainTy TYP° <br /> BF1 Waste Code I�j escrip L— GaranliJl1r— Units Na. Type G-Carton <br /> Descri tion of W_"_ ast© - <br /> --- 0 E' G 1 11 ft T B-flag <br /> ::uu N rstrcfru:; Sui1 ft."1 T -Truck <br /> xiirl:aIiu!r of nnctrrt'1;t'Or]ltri l L P -Pounds <br /> stu!•rtee tank L 1 Y-Yards <br /> ,l ��� � m ❑ O-Oth°r <br /> y 40 CPart iy applicable <br /> I hareby certify that the above named material daas not cottiain free liquid as deltcable state law, has beenproperly described, <br /> state law, is not a hazardous waste as donned by 40 GFR Part 261 or any app <br /> classified and packaged,and is in proper condition for/transportation according to applicable regulations. <br /> ,shil Date <br /> sinynal <br /> Ganarztnr Autltonzed Agent dame _ � ,�.��. ,,,�,. r '-��yr-' �tti• 'i" <br /> _ •115-GO�i-Gt354 <br /> f Phone No. <br /> Truck No. <br /> Il E 1 lard 1'rlu kint;. 111i Driver Name(Print} <br /> Transporter Name <br /> Vehicle License NodState <br /> Address <br /> Byron. Cr:iii•ornia 94544 Vehicle Certification <br /> I hereby certify that the above named material was picked up out inherecentttoythe destinal on listed b Io e named ow that the abriot was delivered with <br /> l at the generator site listed above. <br /> " <br /> •'�7 ��., Dalivery Data <br /> "�- -- sillpmen!Data Driver signature <br /> EDriver signature 4 <br /> a a a <br /> Site Name <br /> Ill Rood L©ndf i i i Phone No. t 1 a 1 <br /> 1001 North Vasco Rd. , Livermore, Cu. 945510 <br /> Address /J <br /> I hereby certify that the above named material has been accepted and to the' est qr knowledge the foregoing is true and accurate. <br /> l 5i nature <br /> it Aulttarized Agent _ - <br /> 1 <br /> PASS CODE <br /> BF1260.720 <br /> 10196 <br /> 1nAifSf ORTER RETAIN <br />
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