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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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! � <br /> rY <br /> Z <br /> Y <br /> No.4017U8 <br /> 0Waste <br /> systems NON-HAZARDOUS SPECIAL WASTE MANIF11 EST <br /> BROWNING-FERRIS INDUSTRIES pi <br /> 1 11 <br /> n. Vim" .: 't^ <br /> pNOCAL Stat i011 �GOlS <br /> LOCAL inr}:eL11M Generating Location��--�-- <br /> Generator Name C,01 V. I,e L L 1 etn;tn Lat`t' <br /> F. <br /> U. Box ;,1111 Address <br /> Address Lodi. C:1 <br /> $nll Malec. Ca. 9,1402 <br /> 3 6 f} Phone No. <br /> Type <br /> Phone No. 1 Containers Drum p-Crum <br /> Quandt Units No. T FB C.Carton <br /> 9F1 Waste Cade Description of Waslo p u 1 >> i <br /> —_----- 0-Bag <br /> T-Truck <br /> i:a;l Iles:t!r;lues Su i 1 fror.. ED= ❑ P-Pounds <br /> e::r:acatlo;i t!C uudergruu;scl <br /> s LuraQe Will, `t-Yards <br /> i ❑ � ❑ o-atnrar <br /> arced material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable <br /> I hereby certify that the above n 4l} CFR pari 261 or any applicable state law, has been properly described, <br /> state law, is not a hazardous waste as defined by <br /> classified and pac}aged,and is in proper condition fD iransporiation according to applicable regulations. <br /> Shipment Date <br /> nl fNarne Signature <br /> G norator fiu4+arized Ag <br /> 415-634-6950 <br /> 1, Phone No. <br /> I � <br /> Truck No.�— Inc. c <br /> Dillard Trucking. Driver Name{Print) <br /> Transporter NameP.O. Box 218 Vehicle License No.ISfate <br /> Address <br /> Byron. California 94534 Vel*ke Certification <br /> i <br /> su !hereby certify that the above named material was delivered wit - <br /> I hereby certify that the above named material was picked p out incident to the'd stination listed below. 1 <br /> at the generator site Ii t d above. ! U <br /> /� off J �c Delivery Date <br /> 7f. '�c. v L oriv ignalure <br /> I - r shipment Dato �/r' <br /> DIMF 1111:101 11,111111 <br /> river 5nature <br /> e s <br /> 0 4 9 1 <br /> B.F.I. Masco Road Landfill ,Phone No. <br /> Slie Name <br /> AiJS <br /> 4001 Nartit Vasco Rd.. Llvermvre. 9455{3r <br /> Address In is Go and accumie. <br /> �i I hereby certify that the above named material has been acceptsd and to the be^t of my knowlrtd9 ih to g 9 , <br /> Recoi t a e <br /> . .t•�� <br /> Si nature Kt <br /> h;,;,ie ofef Author <br /> PASSCODE_ SF1260-720 <br /> 10!86 - <br /> TRANSPORTErt nETAIFI <br /> i <br />
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