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ARCHIVED REPORTS_XR0006739
EnvironmentalHealth
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6230
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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 Paper <br /> i <br /> FORWARD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 5344 <br /> Generator '� S AZ MjSN r <br />' Address G C / - Aj <br /> Phone (Zc-9) y7�- - S Contact <br /> Transporter <br /> Address , U <br /> Phone (ZG�) <br />' I hereby certify that the above nomed material Was. d uLraf 4e-generator site listed above <br /> Driver Signature <br />' Shipment Date q <br /> Truck No e!:- <br /> Load No <br /> 1 Vehicle License No/State <br /> Consul tan t/Contracto r + "� T C- <br /> J N ,l� IJ <br /> Address / /7 r-y <br /> Phone (207) - r, o `'` Contact ___ice �/ ( L2 <br /> I hereby certify that the above named material is consistent with the lrnformatlon presented in the Waste Characterization Form <br /> and Contaminated Sol[Descnption Form,and has been properly described,classified and packaged,and is in propercond'bon <br />' for transport according to applicable regulations <br /> Date z <br /> { 3 .� _ 3 <br /> f r �.E• - <br /> Name <br /> Destination Forward, Inc <br />' 9999 South Austin Road nteca, California 95336 <br /> (209) 982-4298 <br /> Received by <br /> Date - 9-3 -- <br /> l'� <br /> Acceptance Na - 303 - <br /> This load contains sail 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)982-4298 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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