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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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.}; _• - ,.:Z'P i z.rites. ava'y' �, L - '2 <br /> L <br /> M� <br /> p YSez6 ste No. 401709 <br /> Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> BFIOWNING•FERr1I5 1NDUSTMES <br /> II '•tall:+ t'lns;6 UNOCAL StuElon ;G0(0 <br /> Generating Location <br /> Generator Name — <br /> p. (1. Flux ;rr31] _ Addsass Erni E. lit:t t l r'r'tan Lane - <br /> Address Lodi. CA <br /> San ?Satoo. Ca. 9•1402 <br /> Phone No. <br /> Phone No. Containers Type <br /> D•drum <br /> BFl Waste CadeED' Quandt Units No. nT <br /> C-Carton <br /> Description of Waste - ❑ 0 2 <br /> O U 0 1 R 'r' B-13ng <br /> Sun llazar+lwli Sat 1 f rop; T -Truck <br /> esr.aVut.lors of undergr•o!usd EI= ❑ m ❑ P.Pounds <br /> storage tank Y-Yards <br /> I <br /> ❑ � � O-Other <br /> imaterial does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable <br /> hereby certify that the above Warned ma licable state law, has been properly described, <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any app <br /> classified and packag�d,and is in proper con it�o f r transportation according to applicable regulations. <br /> r Shipment Das© <br /> Signature % <br /> Gnneralur Authorized Ag6nt Name ,fT <br /> 415-634-6850 <br /> J 7� <br /> Truck No. Phone Na. <br /> 'r� 1 <br /> Di l lard Tru(,-king. Inc. Driver Name(Print) t <br /> Transporter Name <br /> i%� 775 ill <br /> F.O. Box ?.1a Vehicle License No./State <br /> Address <br /> Syron. califorttia 0454 Vehicle Certification <br /> I hereby certify that the above named material was picked up l hereby certify that the above named material was delivered with <br /> al the generator site listed above, out inrJid nt to the destination listed below. / <br /> Delivery Date <br /> Shipment Date Driver Signature <br /> Driver signature <br /> � J <br /> 11.F.I. Vasr,o RoadLandfillPhone No. 4 1 8 <br /> Site Name <br /> 1001 North Vasco Rd.. Livermure. Ca. 04550 <br /> Address <br /> med material has been accepted and to the best of my`know edge foregoing is true and accurate. <br /> I hereby certify that the above na <br /> ecei 211, <br /> Nt `Auttwrized Air ent <br /> PASS GODe <br /> BF1260.720 <br /> 10!86 <br /> TI MSPOm ER nETAM <br />
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