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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 HII! !ANDFILL, INC. <br /> ' Weighed at: <br /> POTRERO HILLS 1.ANDF 11 6.. INC. <br /> P.O. Box 68 <br /> FAIRFIFLD, CA 94533 <br /> ' Deputy: Janee Ouinonez <br /> Deposit: Janee quinonez <br /> ' BILL TO: 169 <br /> MRC EHVIROHHENTAL SERVICE <br /> Vehicle ID: <br /> ' Refenance: PHLF12022 <br /> Grid: i6 <br /> HaulCust#: ORIGIN-STOCKTON <br /> DrivarOn?: N <br /> ' Route: 66740-04 BIN 3243 <br /> TRLR/I.P#: 9D74430 <br /> ' Origin: STOCKTON <br /> NATE IN: 02/02/2012 TIME 1N: 13:24:13 <br /> DATE OUT: 02/02/2012 TIME OUT: 13:56:04 <br /> INBO1:ND TICKET Number: 01-259475 <br /> SCALE 1 GROSS WT. 66720 LB <br /> ' SCALE 3 TARE WT. 38080 LB <br /> NET WEIGHT 28640 LB <br /> Qty Description Amount <br /> ' 14.32 Profile S0 1-T ADC <br /> ' WEIGHMASTER 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 /> (ce:mmencing 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, 4 <br /> medical waste or liquids of any type. <br />
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