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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 LAN. " -L, NJC. <br /> ' Weighed at: <br /> NOTRERO HILLS LANDFILL, INC. <br /> P,O. Bo, 66 <br /> FAIRFIELD, CA 94533 <br /> ' Deputy: Janee iluinonez <br /> Deposit: Janes QuinOnez <br /> BILL TO: 169 <br /> ' NRC ENVIRONMENTAL SERVICE <br /> Vehicle ID: <br /> Reference: PHLF12022 <br /> ' Grid: 16 <br /> Hau1Cust#: ORIGIN-STOCKTO14 <br /> DriverOn?: H <br /> ' Route: 05740-05 BIN 3339 <br /> TRLR/LPI:: 9074430 <br /> Origin: STOCKTON <br /> ' DATE IN: 02/02/2012 71MC IN: 16:36:12 <br /> DATE OUT: 02/02/2012 TIME OU'i: 17:09:51 <br /> INBOUND TICKET Number: 01-259549 <br /> SCALE 1 GROSS WT, 54060 LB <br /> SCALE 3 TARE WT. 37920 LB <br /> NET WFIGHT 16140 I_B <br /> Qty Description Amount <br /> 6.07 Profile Soil-T ADC <br /> ' X <br /> WEIGHMASTER CERTIFICATE: <br /> ' THIS IS TO CERTIFY that the following <br /> described commodity was weighed, <br /> ' measured, at- 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 <br /> griculture.X (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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