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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
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EHD - Public
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Recycled Paper <br /> I � <br /> FORWARD, INC, NON-HAZARDOUS WASTE DRIVER IDENTIFICATION FORM <br /> 51C <br /> Generator `X) &'J P- <br /> Address 1 ?_ ! &)& C 'T <br /> Phone C7 i �� - . �� Contact U <br /> Transporter <br /> Address <br /> Phone ontact <br /> 1 hereby certify that the above named material was picked up at the generator site listed above <br /> Driver Signature <br /> Shipment Date J� <br /> Truck No A '2z� Lr �3 Load No <br /> Vehicle License No/State10 <br /> d' dress . <br /> nsultant/Contractor AJ <br /> Phone { } - - 3 C� Contact _ A` Z - 'Z-- <br /> I hereby certify that)he above named material is consistent with the Information presented in the Waste Characterization For <br /> and Contaminat n orPDescription Form,and has been properly described,classified and packaged,and Is in properconditi, <br /> for transport a o ing to applicable rations <br /> Name .� Date > r -- <br /> 1 <br /> Destination Forward, Inc <br /> 9999 South Austin Road, Manteca, California 95336 <br /> (209) 982-4298 , <br /> Received by <br /> Date <br /> Acceptance No - <br /> iThis load contains soil with <br /> less than 100 ppm greater than 100 pp <br /> COPY OF THIS SHEET MUST ACCOMPANY EVERY WASTE LOAD, AND MUST BE SUBMITTED AT THE GATE FC <br /> NTRY ALL L.QADS MUST BE SCHEDULED AT LEAST 24 HOURS IN ADVANCE (209)982-4298 LANDFILL OELIVERIE <br /> tMUST BE SCHEDULED ON A DAILY BASIS ANY UNSCHEDULED LOADS MAY BE REFUSED AT THE GATE <br /> Yards Per this Load / 9 <br />' WHITE-FACILITY COPY YELLOW-TRANSPORTER COPY PINK-GENERATOR COPY <br />
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