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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 HILLS L ILL, INC. <br /> ;;elghed at' <br /> ' POTRERO HMS LANDFILL, INC. <br /> P.O. Box 68 <br /> FAIRFIELD, CA 94533 <br /> Deputy: Janee Ouinonez <br /> Deposit: Jan8a Guinonez <br /> BILL TO: 169 <br /> tNRC ENVIRONMENTAL SERVICE <br /> Vehicle ID; <br /> Reference: PHLF12022 <br /> ' Grid: 16 <br /> HaulCust#: ORIGIN-STOCKTON <br /> DrIverOn?; N <br /> Route: 65740-02 BIN 3208 <br /> TRL11/011: 9E75802 <br /> Origin: STOCKTON <br /> DATE IN: O�2/02/2012 TIME IN: 13:26M <br /> ' DATE OUT: 02/02/2012 TIME GOT: 13:53:3-1 <br /> INBOuND TICKET Number: 01-259476 <br /> SCALE 1 GROSS WT. 64200 LB <br /> SCALE 3 TARE WT. 37420 LB <br /> 27780 LB <br /> ' NET WEIGHT <br /> Qty Description Amount <br /> 13.39 Profile Soil-T ADC <br /> x <br /> WEIBHMASTER CERTIFICATE: <br /> ' THIS IS TO CERTIFY that the following <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 /> ' 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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