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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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K <br /> Waste tie. 401712 <br /> SOtems llj NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> nROWNING FERRIS INDUSTRIES <br /> r <br /> I.'NOCAL Mil 1-1- Line t.'�f1CU. station 4+1015 <br /> Generator Name Generating location — - <br /> Address P, 0, 1!o.% 5811 Address ti01 C. Kell.lelutm 1,11"u- <br /> Sail <br /> aneSan Mn Leu. Ca. 0.1.102 �L]o�ddir.�CA <br /> t 1 S 2 7 r 2 3 t Phone Ne. ��]-E==0 <br /> Phgne No. _ r _ --- <br /> �1—� L��Q� Containers TYPO <br /> ru <br /> BFI Waste Code Quantity Units — —1 <br /> T e O-Drum <br /> Oescri tion of Wasto _ Y— — _ C•Carlon <br /> u 0 U 1 tt L� t) / l p.Dag <br /> Noll ilazat-duos Sol! front T-Truck <br /> cr:rnvg (if nndet zt uetrtd m <br /> sLot•a;;c Lli Utak 11 P•Pounds <br /> Y-Yards <br /> ��� ❑ � � O.Other <br /> i <br /> 1 hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable ; <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classified and packaged, and is in proper condition for transportation according to applicable regulations, <br /> • �'� /,%'r� ';'. t Shipment Datej <br /> Cioneraior Authorized l�gont Namo sign¢ure " �' <br /> j 41s-sa�i-solo j <br /> Truck No. Phone No. <br /> Dillard Truckfni~, ]nc. DriverName(Print)�� <br /> Transporter Name k <br /> Address P.O. Box 218 Vehicle License No./Slate <br /> Byron. Callrarrila 94544 <br /> Vehicle Certification i <br /> I hereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- w <br /> at the generator site listed above. out incident to the destination listed below. <br /> Delivery Date <br /> 9river Sign�;ure shipment Cate (,paver Signa�r0 <br /> i rte, T r, <br /> Site Name <br /> B.F.T. Vasco Road Landfill Phone No. <br /> 1001 North Vasco ltd. . Livermore. Ga. 9]530 <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> t <br /> - Signature nacai t Cala <br /> nan Wlrr�ritad A enl�� -- <br /> PASS CODE <br /> aF12r)0.720 i <br /> :alae k <br /> ' TrIANSP0111 I tai BETAIN <br />
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