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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. 401-727 <br /> Waste <br /> osystems " NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> C <br /> LN <br /> UNOCAL Statl0l' <br /> Generating Location <br /> Generator Nal <br /> Addross <br /> Addril:t-- J,f3dl. CA <br /> .71 D phone No. Containers Type <br /> phone Nu. L1 _ L_ __ 1E T D-Drum <br /> -EO= n=,u,,l Units 0. <br /> BFI Waste 'Code L it r,-Carton <br /> Doscri lien of Waste —1_/ 1 3-Bag <br /> [E:�= E Fa nn <br /> f T-Truck <br /> P-Pounds <br /> Ioll of U Idti.,ground <br /> FT <br /> st-11= tank Y�Yards <br /> 0-Other <br /> El <br /> irce liquid as defined by 40 CFR Part 260.10 or any applicable <br /> named material does not contain has been properly described. <br /> I hereby certify that the above 261 or any applicable state law, <br /> State law'is not a hazardous waste as defined by 40 CFR Part <br /> classified and packaged,and is in proper condition for tran-sporlation according to applicable regulations. <br /> shipirrefit DaTe <br /> 7rs 7M <br /> Sidnaiure <br /> 60f,CFalor Auttibrized Agent Mime I ii W <br /> 4 1-3-6334-6850 <br /> Phone No. <br /> Truck No. <br /> pillill-d TruckIng. 111C. Driver Name(Print) <br /> Transpoiter Name <br /> ;, 0 13 u.,,. 2 1�3 Vehicle License No./Stata <br /> Address <br /> [wi,in, Vehicle Certification <br /> ------ material was picked up I hereby certify that the above named material was delivered with- <br /> I hereby certify that the above named stination listed below. <br /> out incident to the de <br /> at tile generalor site liSted abovJ0. <br /> Driver signuture <br /> 131 iver Sit 11,111111 n "Equivniiiiii I'vo mg,Ill <br /> P, <br /> :q r7nffll ljjpi,'''� <br /> ON <br /> R <br /> E, <br /> Phone No.=_ 3 <br /> %,,-scn Ill <br /> Site Name <br /> 11101 No.-th Vasco Rd. . Livellrot�e- Ca- 94530 <br /> Address <br /> my knowledge 1he ioreggjhg is true and accurate. <br /> d material has been accepted and to the best of <br /> I holieby coltify that tile above name <br /> PASS CODE <br /> BF1260-720 <br /> TRANSPORTER RETAIN <br />
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