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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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No.401710 <br /> s ems Im _ ZARDMS SPECIAL WASTE MANIFEST <br /> jo..Iwaste <br /> � N4N HA <br /> Y� <br /> anGWNING-FERRIS INDUSTRIES r 'A, 1{ •�? <br /> 4 ''i• i�s*r1� ;OC.1I. S t.1 t.1 <br /> 921 <br /> —_ <br /> l':+OCr1L l•tlrt i<^.Lind _ Generating location ----� <br /> 1h'E .I lrm+Il i.atr <br /> i Grnerafor Name h[,1�_• <br /> Address <br /> CA <br /> s� <br /> Address ------� <br /> can )i:etFtn. ca. 9lit]� <br /> ' ' r•' fr' Phone No. <br /> L _-t � <br /> + 1 i TYPE <br /> Phone No. Lcrip <br /> — Containers D-Drurn <br /> � Ouantit Units No• T C-Cnrlon <br /> BF1 Waste Cada on of Wast` ^f— d - R p S 8 f3"90p <br /> T-Truck <br /> Noll Ile:=rli dour: Soil Croat P-pounds <br /> } e XC�1v;--t.Ir)- of urider'f roun ❑d }-_�_f <br /> Y-Yards <br /> stul'age tank <br /> 0.other <br /> applicable <br /> described, <br /> part <br /> applicable state law, has been properly <br /> t hereby certify that the above named material ddbOy 400Ccontain t'261 liquidT nys pphned by <br /> state <br /> r40 egulations. <br /> state <br /> or any <br /> state law, is not a hazardous waste as del Y ortation according to applicable <br /> classified and packaged,and/is in proper Con' <br /> for tramp <br /> 1 ��� l(.Ytr•f'�.ci'� .� / /. -.- ' Shipment Data . <br /> Slgnaturo ' <br /> 6encra[or Authorized A ehl Name `.� 9 . <br /> � �..� s y•x r ?I:. .31�^G3•t-61150 <br /> Phone No. �- <br /> i Truck No. '• �Yi}''I!1 ;`j`''f �~---- <br /> Dillard 'fru'Kill' Enc. Driver Name(Print) <br /> Transporter Name �'� <br /> i I.U. Box 213 <br /> Vehicle License No•/State �--- <br /> Address <br /> B}•rort. California 94544 Vehicle Certification <br /> 1 hereby certify that the above named material was delivered with <br /> out incident to the destination listed below. <br /> I hereby certify that the above named material was picked up <br /> at the generator site listed above. <br /> l .-� 1 _•�..L--rl ,� '! �� � OaliverY Da1B <br /> I <br /> Shipment Data Dr=-ver Signature <br /> i, t7rivnr signature !t <br /> rascn Road Landfill Phone No. <br /> 4 <br /> Site Name�- <br /> 4001 ,forth Vasco Rd., Livermore. Ca. 9455 <br /> Address kn wledge tihregoing is true and accurate. <br /> I hereby certify that the above named material has been accepted and to the best° MY <br /> Fit ec�0 � <br /> �nalwa �. <br /> k ai AelhOr�_-zed Agent <br /> ( - PASS CODE�— 6FI2G0-720 <br /> 1 <br /> I <br /> 10.36 <br /> -;FtrfjsPoRT>=n nrrTntN <br />
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