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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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Rgcycled Paper <br /> e <br /> FORWARD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> A <br /> 5140 <br /> enerator CA P.A _6 0 <br /> Address O L -�-0 <br /> Phone (Zej) �6 — - s Contact rid A A) <br /> Transporter A2- / <br /> Address <br /> Phone (2yg) 9 -Contact <br /> 1 hereby certify that the above nad material was picked up ache 4efierator site listed above <br />[ Driver Signature 71 <br /> Shipment Date <br /> Truck No � Load No <br /> Vehicle License No /State { ` <br /> nsu ltant/Co n tractor =1j6 <br /> dress 7 <br /> Phone (Zp�} 9s1 - Contact ` <br /> f hereby certify that the above named material is consistent with the information presented in the Waste Characterization Forr <br /> and Contaminated Soil Description Form,and has been properly described,classified and packaged,and is in propercondltio <br /> for transport <br /> acco dmg to applicable regtions <br /> Name -111 Date <br /> �' f q <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Mca, California 95336 <br /> (209) 982-4298 �I <br /> Received by <br /> Date J - 1 <br /> Acceptance No =1?_3 - _ 3? <br /> IThis load contains soil with <br /> Iless than 100 ppm greater than 100 ppn <br /> WOPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FOF <br /> RY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERIE: <br /> EMUST BE SCHEDULED ON A D ILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load <br /> WRITE-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />
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