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ARCHIVED REPORTS_WELL DESTRUCTION REPORT
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0522692
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ARCHIVED REPORTS_WELL DESTRUCTION REPORT
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Last modified
4/2/2020 4:41:19 PM
Creation date
4/2/2020 2:44:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
WELL DESTRUCTION REPORT
RECORD_ID
PR0522692
PE
2957
FACILITY_ID
FA0015465
FACILITY_NAME
FORMER MONTGOMERY WARDS AUTO SRV CTR
STREET_NUMBER
5400
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
10227008
CURRENT_STATUS
01
SITE_LOCATION
5400 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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' POTRERO HIL _ANDF1LL, INC. <br /> Weighed at: <br /> ' POTRERO HILLS LANDFILL. iNr <br /> P.O. Bax 66 <br /> FAIRFIELD, CA 94533 <br /> Deputy: Janee Ouinonez <br /> Deposit: Janes Ouinrnez <br /> BILL r0: 109 <br /> ' NRC ENVIRONMENTAL SERVICE <br /> Vehicle or <br /> Reference: <br /> ' Grid: 16 <br /> HaulCustit: ORIGIN-SIDCKTON <br /> DriverOn?: N <br /> ' Route: 65740-CONSTRUCT <br /> TRLR/LPii: BIN 3244 9E75803 <br /> Origin: STOCKTON <br /> 1 DATE IN: 02/02/2012 TIME IN: 13:17:16 <br /> DATE OUT: 02/02/2012 TIME OUT: 13:58:05 <br /> INBOUND TICKET Number: 01-259474 <br /> ' SCALE I GROSS WT. 5G660 LB <br /> SCALE 3 TARE WT. 36380 LB <br /> ' NET WEIGHT 20280 LB <br /> Oty Description Amount <br /> 10.14 MSW/T(TRASH ON SCAL) <br /> 1 <br /> ' X _ <br /> WEIGH14ASTER CERTIFICATE: <br /> ' THIS IS TO CERTIFY that the fellu.,ing <br /> described commodity was weighed, <br /> measured, or counted by a weighmaster, <br /> ' whose signature is on this certificate, <br /> who is a recognized authority of <br /> accuracy, as prescribed by Chapter 7 <br /> (commencing with Section 12700) of <br /> Division 5 of the California Business <br /> and Professions Code), administered by <br /> the Division of Measurement Standards <br /> ' of the California Department of Food <br /> and Agriculture. <br /> X <br /> (Deputy Signature) <br /> 1 This is to certify that this load does <br /> not contain any hazardous materials, <br /> ' medical waste or liquids of any type. <br />
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