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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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Tags
EHD - Public
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_,��" '"c '- errs vr.= <br /> f'¢ r .z,� - <br /> r x' A'k-R. <br /> S <br /> J <br /> 1 <br /> I <br /> Wast '# <br /> Na U U (��jE <br /> f = NON <br /> -I-{AZ/1RDOUS SPECIALWASTEMANIFEST <br /> C1IlOVltJlrlG rCElrllS rr4ous I nwsr <br /> Addles, <br /> _ - <br /> Addles <br /> 1 i I Cont rl crs .U um <br /> Phone No "•Jl <br /> BFI Waa1c(:adr .. - 1 --- ouanlity Units TYPOCalton <br /> Na jL 4 C <br /> 1]escnptku,of W i'te"--. . <br /> __ •Fang <br /> _ T •Truck <br /> ff l l l P•founds <br /> y.Yards <br /> O Otltnr <br /> 1 herrby certify <br /> ill-,It Rhe above Warned material does not contain <br /> Ire( kiquid as deAned by �o CFR Part 2Fi0 10 or any pp <br /> slaty late: is not a hazardous waste as delined by 40 CFR part 261 or any applicable stale law, has been properly drscribccf, <br /> classified and packaged• and is in proper condition for lransp'rlalion according to applicable regulations. <br /> SlripmF,i rt Data <br /> Genco fur Sol. <br /> zr'1 Ag,r,f SJarnC },p. - 1 <br /> 11�� u ..p. Si{F'`'i'+F•'-,�jjF r'� ',Y'k&'`�J7• <br /> IT <br /> -._ •-•� Phone Ido. <br /> Truck No. •-.__`--- -- — _r. - <br /> 1 i 1':• _�_ Oliver Narne(print) <br /> Transporter <br /> Vehicle License No.lState_— Y <br /> Address ---- <br /> Vehicle Certification _"-1 <br /> t hereb certify that the above named material was picked up I hereby certify that the above named materiaE was delivered With- <br /> y out incident to the destination listed below- <br /> it ele generator site listed above, <br /> l /: Jf�.-..- ����`-� 1� .�S—f�` =- --����—..•' ---- pnfivery o,le, <br /> ,y` UnYur$�gnptt,i� <br /> __ $ItiJ,rnnnl 031C �• <br /> F,i,et <br /> wq <br /> '•2 �'�'. }�-�'-.� .�C.�:+�ri't�ajs�j,:�; k��;r.43 �'���'����� ,_,;�?��.,:.p r�' <br /> (Phone No. ' <br /> Site Name =- <br /> Address <br /> maleriel has been accepted and fo the best al my knowledge the foregoing is true and a <br /> I hereby certify that ilia above named <br /> � <br /> r — � <br /> • Receipt cuts <br /> S""at <br /> ury -- —_, -- <br /> PASS GOOF (IF 1,60 i20 <br /> t0rRF, <br /> -11,x1+r,l'r,r�rf-i,,ir }•'.1`I <br />
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