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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 Paper <br /> FORWARD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> enerator ��1 � J 536.1 <br />' Address _ +O C _ <br /> Phone ( ) - - s�� r Contact NI — <br /> I � <br /> Transporter MR ��,�.S��r`02_ <br /> Address <br /> Phone (ZoJ ) 9c °°ct <br /> I hereby certify that the above named atenai was picked up at thegeneLrator site listed above <br />' Driver Signature ' ,,�! �4�-g� <br /> Shipment Date - -.23 _ <br />' Truck No 4Z-Z' ' Z. Z Load No <br /> Ve6cle License No/State <br /> 0nsultant/Contractor <br /> - <br /> t <br /> dress _Sf� 3-7 � <br /> Phone (-ZO7) 9-T-) - 15!�O Contact fq iL a kj b!�� <br />' I hereby certify that the above named material is consistent with the Information presented In the Waste Characterization For <br /> and ContaminatecbSod Description Form,and has been properly described,classified and packaged,and is in proper conditic <br /> for transport according to applicable regulations <br /> Name __ Date <br /> Destiration Forward, Inc <br />' 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 r <br /> Received by <br /> Date I <br /> Acceptance No - <br /> This load contains soil with <br /> less than 100 ppm greater than 100 ppi <br /> OOPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FO <br /> TRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERIE <br /> MUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> k � <br /> Yards Per this Load r �` \�r _ L . _ <br /> WHITE-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />
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