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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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BENJAMIN HOLT
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2200 - Hazardous Waste Program
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PR0517880
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
7/27/2020 8:37:58 AM
Creation date
2/24/2020 11:02:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0517880
PE
2220
FACILITY_ID
FA0003625
FACILITY_NAME
ARCO STATION #83560*
STREET_NUMBER
2908
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09763032
CURRENT_STATUS
01
SITE_LOCATION
2908 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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10/18'/02 FRI 09:21 FAX 949 450 1177 B.E.S. I. 003 <br /> Stare of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-00391Expiras 9.30-99) See Instructions on back of page 6. <br /> Department of Toxic Substances Control <br /> ,Please print or type. Form desigrted for use on elite f 12-pitch)typewriter. Sacramento,Substances <br /> California <br /> UNIFORM HAZARDOUS 1. Generalor's US EPA ID No. Manifest Document No, 2. Page 1 Information in#heshoded areas <br /> WASTE MANIFEST is not required'.by Federal law. <br /> of <br /> 3. Generators Name and Mailing Address A. Stale Manifpel3lpgUmant mfaltt <br /> BP West Coast Products LLCf <br /> o <br /> h P.O.Box 90877 B: Slate 00p6rch <br /> A. Generators Phone 1 �;]o 17 -46W LOS Angeles,CA 90009 <br /> sCV 5. Transporter 1 Company Name 6. US EPA ID Number C. S"TrogspprleY-s ID Rea <br /> WBelshire Envirarlrnerlt.al Se rviceSInc IC D 19 18 13 18 14 0 18 l D• tran:pattei� hah <br /> 7. Transporter 2 Company Name 8. US EPA ID Number e;::Skill T+on • <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G:.:Stole fpcllity�siD <br /> :r:5 DeMenno Earldom <br /> Z ' <br /> 2000 North Alameda Street K Foc11kVl;Ph,-0 ' <br /> a C CA 90222 C T O $ 0 0 ] 3 3 1512 { 1 �S3"! 04.: <br /> J <br /> �U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 1A, Unit <br /> �Z a No. Type Quantity WI/Vol 11",/{psl�NpMber <br /> Gasoline Mixure 34 <br /> _ 3 <br /> 3 U91203 P.G.n <br /> 3 G N (Not R.eeWated as a RCRA Waste) D M 0/ 6 G j 711. <br /> >PA7Q�hrt;}:<a.:>`, <br /> c b. <br /> Co E - <br /> R kP Jk� er 1 <br /> v A <br /> o T C. <br /> W O <br /> R Lp er <br /> Ztgte <br /> W <br /> Vf! J!tt3�}le ; <br /> W <br /> V) J.,clditionoLDe�cdptions for.Materials Listed Above <br /> Z K. Handling Lodes kr VJastirlirtad}4bove <br /> O 2000 Nati American EMERGENCY RESPONSE�GUME NO. 128 s <br /> W The LDR Natificatim statanaat is not as of J 1996 <br /> ?d Y! c. <br /> HSC Citation 2517915: <br /> Q f' <br /> 0 15. Special Handling Instructions and Additional Information <br /> z <br /> Gasoline and Water mime. Wear appropriate protective lathing. ARCO 2133 BEST# 53987 <br /> (Ng) 753-58M(24 har Eme 1pericy Phare) 2906 Benjamin Holt Drive <br /> LU <br /> (949)450-1010(Man-Fri lam to 5=) Stodctcn CA <br /> QI& GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> V marked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 1 If I am a large quantiy generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> V) practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR, if I am a small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and that I con afford. <br /> VPrinted/Typed Name Signature Month Day Year <br /> Z Larry ry MooffimtIBFM as agmt of ARCO <br /> Ur 1 17. Transporter 1 Acknowled ement of Receipt of Materials <br /> W N Printed/Typed erne Signature Month Day Year <br /> w 5 <br /> 1A4ZP)%j L9 f- <br /> 018. Transporter 2 Acknowledgement of Recei t of Materials <br /> Q B <br /> to Printed/Typed Name <br /> Signature Month Day Year <br /> N E <br /> Q B <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> - A <br /> C <br /> 1 <br /> L <br /> Iility Owner or Operator Certification of receipt of hazardous materials covered by this manifest awVht as ted inJWWI9. <br /> T rioted/Typed Name ( Signature nth Day Year <br /> Y 11 t o.—kA- b \al <br /> DO NOT WRl n-LO T <br /> DTSC 8022A 11/991 White: T5DF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />
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