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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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F <br /> F <br /> , <br /> r1D. 401722 <br /> Q-u' <br /> Waste � � <br /> systems _ AZARDO ,S SPECIAL WASTE MANIFEST <br /> NON N T . . . <br /> r11S I1JnUSTM <br /> gROWtJ11JG FErJ E5 �, rF. v • �-�.,,` �, " ,• '" ?' a, <br /> (:NOCAL Station =f+01 <br /> r,,o(:Al, }trlrf et lnl; Gerterlting Locattpn <br /> Genorator Name -- f,01 E. Kr Lt.l�snan Ls1n r — <br /> Address ----1 <br /> P. 2' Elo4 5Esi1-- y�_�_�.a-�-- Lodi. CA — <br /> Address�-----�_'.—�� —_ 02 � >r <br /> sell Knteo. Ca. D4,1 <br /> Y 1---- <br /> 1 t ; ;.------------ <br /> 2 0 6 L~ f Phone No. TypePhons No. D=TD <br /> ContainersproL l _� [ �� �7 t� _ Units rdo� Type C-Carton <br /> E— Quantsl — <br /> BFl WaSt©Code pe,cri tion of Waste 0 1 R� i yE �� 9 Dag <br /> — T-"truck <br /> lnrs Bazrarcious sell rr0r. ❑ [� P-PoOlds <br /> c�ca,atlon or undLrgr aunll L—i -y rd. <br /> story:gam tank � � � ❑ 0.other <br /> � applicable <br /> 40 CFR Part 260.10 or any <br /> 40 GFR !'art 281 or any applicable slate taw, has been properly described, <br /> I hereby certify that the above named material does not contain free liquid as deli Y <br /> orlt ion according to applicable regulations. <br /> slate law, is not a hazardous waste as defined by <br /> cl-lssified and packaged,/and is in proper condilia�t far ansp / <br /> Snipmanl sato J. <br /> ,4J2_' •� "Signalu,e' - : <br /> e r]ama <br /> 'GonoratorAulhorizet1Aa •0 , <br /> r <br /> Phone No.--1— <br /> Truck ND. <br /> Uillurd Trucking, Inc. Driver Name(Print) <br /> Transporter Name <br /> 2I8 Vehicle License NO./State <br /> P.O. Bhe <br /> Address — <br /> B}ran. 113541 tifcationCalifornia Vehice C'G <br /> ed material was picked up f hereby cntttn the destination listed below. <br /> material was delivered with- <br /> 1 hereby certify that the above nam out inclde <br /> i at the generator site listed above. <br /> �.sGShipm©ql Date a asiver 5ignalw <br /> I r $ IIjIjjI!;p!!II11F!11I1'I, <br /> i Driver Signa fes„ ! t -N; MEMOPF <br /> '� ° ;�Mw <br /> 3`ar �ircS� 4 s b. r 5 4 4 q 0 <br /> Phone No. <br /> 1 1 <br /> B.F.I. Vasco Road Landfill rJ4580 <br /> site Naml� —�- <br /> 4001 `ortlt Vasco Rd- • Ltver�+orc. C$r <br /> Address�-- N 1s true and accurato. <br /> ' knowledg©the foregoing• <br /> I hereby certify that the above named material has been accepted and to the besyOf my <br /> St <br /> r �;Alirhon.ed A er[ <br /> 11 Y__.._r•� .. PASS CODE aF1260-720 . <br /> �I <br /> 1 <br /> 1 ei 66 <br /> TRADl5POElTLFi RETAIN <br />
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