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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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.r <br /> r <br /> No, 401.721 <br /> Waste <br /> TM <br /> ��� � SPECIAL WASTE MANIFEST <br /> HAZARDOUS <br /> - NON- <br /> f3illING FEi1RIS INDUSTRIES • . ,, ;_ t �. f ',,." �� a� <br /> 71177 oa'�°, c 77 �� s1a. tion =Gott <br /> UNOCAL ;jarketinl: Generating Location <br /> Generator Name G01 F.. 1:ettI(M'ln Lana <br /> Address— <br /> P »p g, 56l i Address <br /> Lodi. CA <br /> '- <br /> Sall 'luteo. Cl ti•1102 <br /> 2 3 ^6 a Phone No. L_.-M� Tyke <br /> Phone Na. � L.� containers <br /> I-prom <br /> Q:0 <br /> Units Na e C.Carton <br /> 13F{waste Code t]escri lion of Waste 0 0 0 1 zf 0 ,i` 13-Bag <br /> T.Truck <br /> \un il;:zz=ruous Solt f ramr-r-•� ❑ <br /> kL l�! p.Pounds <br /> t:xr;i:vatian of undergroundy-yards <br /> stor::fie tank <br /> O1hor <br /> IE ❑ -- <br /> by 40 CFR Part 280.10 or any apP <br /> livable <br /> 40 t co Part free <br /> or any applicabie state law, has been properly described, <br /> I hereby certify that the above named material does not contain free liquid as definedilcable regulations. <br /> slate law, is flat a hazardous was <br /> as defined by <br /> classified and packaged, and is in proper condition for transportation according to app' <br /> 1 ��5 llrlf'"r /� ,, _��— ' shipment D310 <br /> •fir;r. -�r.a s gignalure <br /> GeneTltor Authaiized • . <br /> ;�� � d15-831 6850 <br /> Phone No. , <br /> Truck No. -- <br /> Dillard Trucking, Inc- Driver Name(Print) <br /> Transporter Name— <br /> 1989r' C�� <br /> P 0 Uah 218 Vehicle License No.IState <br /> Address <br /> Byroll. California 94544 Vehicle Certification <br /> ,picked up !hereby certify that the above named material was delivered wiih- <br /> I hereby certify that the above named material wasout incident to the destination listed below. <br /> at the gerlerall site lis above- �� u Q <br /> f j <br /> (7 f Delivery <br /> pgnalura <br /> -•: '� Shipment Dale _ <br /> 'Drive,Signature ' <br /> • <br /> ra ' 1 8 4 4 7 0 4 9 1 <br /> B.F.I. Vasco <br /> Road Landfill Phone No.E <br /> Site Name <br /> are• Ca- 94550 <br /> 4001 tiortli Vasco.Rd.. i.iverm <br /> Address knowledge the regoing is true and accurate. <br /> I hereby certify that the above named material has been accepted and to the best of my i <br /> r, <br /> Receipt Dale <br /> ------------- .....__.... .-----.....- -.................. <br /> ..... _..--------Si nature-... <br /> Nan,..v�d Ane_.. nt i <br /> PASS GODS <br /> 5F1260-720 - <br /> 101[i6 <br /> TRANSPORTER RETAIN <br />
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