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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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waste, <br /> _ SCS rr., SPECIAL WASTE MANIFEST <br /> NON-HAZARDOUSsyst !,. <br /> ❑t]owr,!itc r-enms I:]au; ICa T,.�„,�.,�.......,-+? e } ,; � +�-__ �'i _-_..___ �-_.� _ <br /> Ge^orator Mama <br /> Address __- <br /> Address <br /> Phone hSo. or t i r <br /> Type <br /> Phtino 1`l0 — -' �-__.S C i utc s <br /> I7 LSI I <br /> - l___t- L [. 1 r <br /> } ti,_ L_. Units No. Tyle <br /> �,_ �__ Qtlantily !l <br /> t <br /> C.Cpr10 <br /> EIFI Wash Cn:v D scripUan of Wasle — -- I n <br /> - -- L t��.=� �__ Lel l I 13.r3a� <br /> T .Truck <br /> P.Pounxls <br /> Yirdr <br /> p_Ullrer <br /> -L—'o�any applicable <br /> _ -- — 40 CSR Part 260.i0ro rrly described, <br /> l hereby certify that the above named material does not captain free liquid y s W is d byMe jaw, tias boon <br /> n ktazarIbov vlasle as defined by 40 CFR Pal t 261 or or t 4icabllicable regulations. p p <br /> slate 1,1W, is °�t ' condition for transportation according to app <br />' classified and packaged, and is in proper C I� 1 /l <br /> � ,:.]i•',' ;1�"y/ 1 j i..�-._ r _ �-T y--�-- Shlpmenl Dale! <br /> R,���•,i�;�-U'��jj��..�_ <br /> t Cc•,^r:itc Auitu.nLed! is x _s .K_ b_.y��, /r•'7. .,.4 ,R. :.. <br /> Phone <br /> Truck Plo...--—--� <br /> f + t <br /> Driver 1`411110(Pnnl)- I..— - <br /> '1'ransparler <br /> Vehicle License 1`10.lSlale <br /> Address Vehicle Cerli!icat;ort__._-._., -- -- <br /> .i. <br /> _-.—r�- <br /> "- --�— picked up 1 hnreily cerlily lhttl the ahr1''- luuned material was delivered wtt - <br /> aul incidcl]l to lhn de5liit�+liurt listed bolo d. — <br /> 1 hereby ccrlily t1]at if]e above named material wasp _ <br /> lar site listed above. T <br /> 4l the genera Will <br /> Dohv <br /> nnvr yyinauno er <br /> i <br /> + -� + ra-14.. ,�.Y�� + _-:=.•:r.�Z <br /> a, a /ti -- <br /> r{'.' <br /> PhOiIC N0., Y1�—��� i! <br /> Site Ninle <br /> Address.--- -- �`- ~� kriotUferfye the foregoing is true and accurate. <br /> certify ilial the above named Inatorial has been accepted and la the best^o !my� r _ <br /> 1 hereby f✓I` 1 i / neceipi D03 <br /> - <br /> - _ <br /> S'M1SS CObE pF12G0.72� <br /> InBs itt nrl .�•(:1!'!,lf=f� C �1t11[l <br />
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