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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
Scanner
LSauers
Tags
EHD - Public
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Recycled Paper <br /> a � <br /> --------------- <br /> •*s <br /> FORWARD, INC. NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 514E <br /> enerator CAP-)='_ JPA__S C�e.Lj_L4 14 <br /> Address lJ lC <br /> Phone �) L/,? Contactx'6,0 0 C,4 ti1&AA <br /> Transporter L �— <br /> r _ <br /> Address 145 3 3 _ <br /> Phone ( �) _� - -ego �a itact -- 4 i'Y1 <br /> I hereby certify that the a named matjenal was picked up at the generator site listed above <br /> fDriver Signature <br /> Shipment Date <br /> Truck No T' Load No <br /> Vehicle License No /State �� r <br /> nsultant/Contractor• [J 0-7-16&J,j0 <2-4) <br /> dress cc �� /? <br /> Phone 7) -1 - 93,0 e-1Contact - L��{ 0-- <br /> z ,&►.C) b4�. _ <br /> 1 hereby certify that the above named material is consistent with the information presented in the Waste Characterization For <br /> and Contaminated Soil Description Form,and has been properly descrioed,classified and packaged,and is in proper conditic <br /> for transport a / ing to applicable r Mations <br /> Name Date _ - <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (299) 982-4298 I' <br /> Received by ` , w ` --• <br /> Date <br /> - - <br /> Acceptance No � 3 - _._ 0 _ <br /> This load contains soil with <br /> less than 190 ppm _ greater than '09 ppi <br /> OPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE F01 <br /> 6-TRY ALL LOADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL DELIVERIE <br /> IMUST 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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