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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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i <br /> Nr11y <br /> IMM <br /> Waste No 48C-�117 <br /> � ����.wY , Nr--O-••*N-�+-++r-"�-AZ"cARDGUpS� SPECIAL <br /> L� y.:WASTE <br /> 3i....MANIFEST <br /> 131io4imc.rEMIS 1117USttCS i , <br /> r..._. .......-......__ <br /> ' ! Genorn[ing Location-._. <br /> Gencralnr hlamn ---- -- <br /> Address <br /> r�� �:_ I---1 -- 1_� 1 _..f _�l 4 � F'Itosie tdn -(� 1 .I. �1 _. _ ---- <br /> r�l,onc hJo. I._-l. <br /> - - Canto <br /> i <br /> .1 .1 -..L l 11 1. 1 - 1 - I -- <br /> i3E-1 Waste Code i 1 __ 1 I 1_. ()ulnlitY-- Units TNn. rY�?o o.Druill <br /> Descrip,iDr,of Waste <br /> 1F_U L_1 I l Ll <br /> _._. T -'truck <br /> P -Pounds <br /> Y-Yards <br /> .'. _ -I O Other <br /> icablo <br /> I hereby certify that the above Ii-tined material does not contain free tic;uid s�pefined by 40 CPR Part 2fi0.1G or any app <br /> state law, is not a hazardous v+asleas dcondition for CFR Patation or <br /> rcany a to appiicablecable eregulationslaw, has Ee1} properly described, <br /> classified and packaged,and Is+ proper <br /> ! <s. <br /> GenCraror ruthOnzcd ngelit h!',rna yL A t <br /> �.��_-�.�:i��.-_zw3..srL,..r�_�:..+:".AFL`-ax rs..s...-�.•—.. i�:isa.J :I_. t f. _ X11 ,..- <br /> Phone No.— <br /> Truck No. <br /> giver Name(Print) <br /> Transporter Name J� <br /> Vehicle License No.151ate-2!� <br /> Address r <br /> Vehicle Certification <br /> ----- — <br /> - <br /> t hereby certify that the ahm,?named material was delivered vrith- <br /> I hereby certify that the abovi, named material was picked up olst incident 10 the destination listed below. <br /> at the generator silo listed above- <br /> , 1=:12— <br /> sh r Inert Dille Driver iign',VIP <br /> Dri,or SIr}rsmuro .._�-; A;C x, rM�7 <br /> '-77. <br /> .. tom. - - , }y.. .- a.,:: <br /> Phone Na <br /> 1 I_:.J <br /> Site Narne <br /> Address —� <br /> al has been accepted and to the best of my knowledge tale foregoing is true and accurate. <br /> 1 hereby certify that the above Warned motor! <br /> _ - - -.-- - - <br /> ,___—__.-- '�--�----�----- recti s Date Ps., <br /> PASS CODE <br /> DrF2GU72U <br /> 10'116 <br />
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