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ARCHIVED REPORTS_XR0006739
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0543479
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ARCHIVED REPORTS_XR0006739
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Entry Properties
Last modified
5/5/2020 10:38:48 AM
Creation date
5/5/2020 9:51:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006739
RECORD_ID
PR0543479
PE
2960
FACILITY_ID
FA0024679
FACILITY_NAME
CANEPA'S CAR WASH
STREET_NUMBER
6230
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
081360030
CURRENT_STATUS
01
SITE_LOCATION
6230 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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LSauers
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EHD - Public
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® Recycled itp.r T r5�3-36 3 <br /> FORWAAO, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> s • <br /> 5368 <br /> Generator ilL4 <br /> Address AI (M Ic A J'�-_ "r61 <br /> Phone (20) - ���5- _...Contact �.,GE 4:id Q L)A'a I f='�A _ <br /> Transporter <br /> �r <br /> Address1<=,4j <br /> Phone ( �j ) _ - v�iatact <br />' I hereby certify that the above named matenat�was picked up at the generator site listed above <br /> ,I pu <br /> Driver Signature ('--�� �� —� 4'�7 <br /> Shipment Date -3 r Z 51 <br /> Tuck No G -Load No <br /> Vehicle License No/State Ll 41 � <br /> Con su I tant/Con tractor C7T ' -r/ <br /> Address -7 A 1 f � r <br /> ca r <br /> Phonet Z9�) ^�1�I - ! - Contact 1` <br /> I hereby certify that the above named material is consistent with the information presented in tine Waste Characterization Form <br /> and Contaminatea Sohescription Form,and has been properly described,classified and packaged,and is in propercondition <br /> for transport accordt'nq to applicableregulations <br /> Name t��, � Date 3 + -Z -� <br /> Destination Forward Inc <br /> I 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 <br /> Received by �. t --- -t ti--- <br /> Date <br /> Acceptance No <br /> This load contains soil with <br /> less than 100 ppm greater than 100 ppm <br /> A COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOR <br /> ENTRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-42'98 LANDFILL DELIVERIES <br /> MUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load <br /> - WHITE-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />
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