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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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SJGOV\sballwahn
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EHD - Public
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POTRERO HILLS LANDFILL, IMC <br /> I'leighed at: <br /> ' POTRERO HILLS LANDFILL, ING, <br /> P,O. Box 69 <br /> FAIRFIP-ID, CA 045'33 <br /> Deputy: Jaclyn Deleon <br /> BILL TO: 169 <br /> NRC ENVIRONMENTAL SERVICE <br /> Vehicle ID: <br /> Reference: PHF12022 <br /> Grid: 16 <br /> ' HaulCustll: ORIGIN-STGCKTON <br /> Driveran?: M <br /> Route: REPLACE HANDTAG 04351 <br /> TRLR/LP#: 2192/9175802 BIN# 3341 <br /> ' Origin: .STOCKTON <br /> DATE IN: 02/02/2012 TIME IN: 10:18:39 <br /> DATE OUT: 02/02/2012 TIME OUT: 10:18:39 <br /> ' INBOUND TICKET Number: o1-259409 <br /> ' MANUAL GROSS WT. 61340 LB <br /> W460 LB <br /> MANUAL TARE WT. 23880 LB <br /> NET WEIGHT <br /> ' <br /> Qty Description Amount <br /> 11.94 Profile Sall-T ADO <br /> WEIGHMASTER CERTIFICATE: <br /> ' THIS IS TO CERTIFY that ilia 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 /> • t <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 /> r <br />
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