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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
Scanner
LSauers
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EHD - Public
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Recycled Paps 9 3 <br /> j 11 <br /> M. <br /> t C <br /> FORWARD, INC.' NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 5352 <br /> f <br /> k Generator AAJclp �2 A <br />' Address 3v <br /> Phone (209) <br /> y�$ _ SS/ Contact 14 <br /> Transporter <br /> Address <br /> Phone (ZO�) Contact <br /> 1 hereby certify that the above named material was picked up at�t4egenerator site listed above <br />' Driver Signature -- <br /> Shipment Date 3 Z <br /> Truck No LA Load No <br /> Vehicle License No/State <br /> Consultant/Contractor !0 A) <br /> Address 's <br /> Phone ( 2r" ) —5–y-1 - _ 9 30� _Contact <br /> I hereby certify that the above named material is consistent with the information presented in the Waste Characterization Form <br /> and Contaminated S&Description Form,and has been properly described,classified and packaged,and is in proper condition <br /> for transport according to applicable regul. fk4s <br /> Date <br /> _ 7 <br /> Name - <br /> 1 <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Mant , California 95336 <br /> (209) 982-4298 <br /> Received by <br /> Date - <br /> Acceptance No - d <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)982-4298 LANDFILL DELIVERIES <br /> MUST BE SCHEDULED ONEA DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br />' Yards Per this Load <br />' WHITE-FACILITY COPY YELLOW-TRANSPORTER COPY P[NK-GENERATOR COPY <br />
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