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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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T <br /> f Waste 48032 <br /> Syste ns ,, NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> rinowrnru;.rennls mousrnlEs <br /> 11111711 <br /> ,•f. ° " c Lft:rX'AT, statidit HAl l'i . <br /> LltXX'AI [Intl;aLlnrJ GonomlingLocation <br /> — -- <br /> Gr.n^calorFiarnenddross— <br /> Gi11� E. VCLticr;lll <br /> e <br /> nrrdr .s'---- t=. r.>r. I,_�x <br /> f err 11x1 eo, t'r�. 94401. [Itxli r [A. <br /> 1 I ; —�?. 1 EE-13j:61I} phone No. <br /> Phone t1a. _ _ t <br /> )' �� Canlarners TYPe <br /> -_C1 �1.- I� [TlSI�_� C� 1_.-.--- _ - <br /> I3F1 Waste Cocoa Quantity Units fro. Z Yp0 C•Cnrtan <br /> Descu ion of Waste _ � � ( r <br /> 1— I .Trock <br /> I`011 llc"1Zc rLIoL� :it'll (rCAtr <br /> p -potrnds <br /> ���� <br /> e.: atrleSc+n ot: wlcr.ryrowtc3 <br /> aLOrcrsL' talk, Y-Yards <br /> O•other <br /> r--_�- ------' <br /> I hereby cerllry lhnl 11113 above nanied material dons Fiat cortlair1 rree liquid Y s dallnad by At CFl, Part?F� r, p or pay applicable <br /> stare law, is nal a hazardous waste as dellned by 40 CI Fl Part 261 or air licahle slate law, has been property described, <br /> Classified and packaged,rand is In proper condition for tra apojtatioll, coording 10 applicable regulatioru, <br /> y/ 1 51s11rmenl Dalc <br /> (; c--t)r Au11FOFized Agent tlm--� n <br /> 415-634-6850 <br /> _ Phone No. -�"—"---- <br /> Truck No. 1 � <br /> Dillard TrMkitlg, ITIC. Driver Name(Print) <br /> Transporter Name �/ S <br /> Vehicle License NoBta1e <br /> Address <br /> It4rrt�n, Calilorn.ia 94544 VOhicle Certification_ 7�d� <br /> material was delivered with <br /> - <br /> I Itereby certify Thal the above named material was plcked up I heraby certify chat 1110 above named <br /> at the genoialor site listed above. out Incident to the doslinalion "-ted below. <br /> g2M/ V�.-tG .o flolivnry natn <br /> X Shipment Oale Orlvnr Signntwo <br /> Qi ivr�r7.$iQn lSlFf nay <br /> L.r'.3,. V:tSCU f'r.:.s+.l t��tlr,It ill. Phone No. <br /> Site Name ca. 9455U <br /> �1UL11 IkrrLI1 Fts�cn }lcl., tr.iaecnorra, <br /> Address <br /> hereby certify that the abov0 named material has Leon accepled and Jo,lh best or my knowledge the foregoing is true and accurate <br /> _ -- - <br /> 51 nature <br /> ti <br /> PASS CODE <br /> aF 12G0-7251 <br /> t e1P G <br /> I RANSP0111 Eft DETAIN <br /> _ y.r�l�ilr ,ter' <br />
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