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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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3333
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2200 - Hazardous Waste Program
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PR0515369
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
11/19/2024 1:51:16 PM
Creation date
5/19/2020 3:39:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0515369
PE
2227
FACILITY_ID
FA0006167
FACILITY_NAME
WESTERN TRUCK CENTER
STREET_NUMBER
3333
Direction
S
STREET_NAME
STATE ROUTE 99
City
STOCKTON
Zip
95205
APN
17909003
CURRENT_STATUS
01
SITE_LOCATION
3333 S HWY 99
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\dsedra
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EHD - Public
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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number1 l k 7 Mg 2.Page 1 of 3.Emergency)Re poen se Phone 4 Manifest Tracking Number f p <br /> WASTE MANIFEST w °' - I.'- ` JJ <br /> 5.Gen!faftor's(t�apfearjd ajfng/)ddr vss EV,W c.2170 Generator's Site Address(if different than mailing address) <br /> 1�4'l � �r f qF spa` <br /> Fi i 04 �u s)i.t f,`,rl a,s�•:u"�..� �,4. .': '�:,9 I`)ftM;1 e'4:��ra r'LkS.§ <br /> Generator's Phone: <br /> I.Trans orter l °mPa yNa ejt $,'6t1' (. Grp, t a 1=.x U.S.EPA ID>Nu;Ietr, Y-£ t, p r),? <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility N.T.and�SjjtRddlessa U.S.EPA ID Number <br /> 9�R�,,z Z, mt-fxa t .rn�, <br /> 75 {ffz"twt BOYLE AN041if <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> t». ",lfr.,13.4 V°s:°.Y 7°."912,54 <br /> � v <br /> 40 zk <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> V IFTI Or NCY fir i•4`AC f P )-ATK ) 00f) y2 0 4th.Wf" ,?NIIVNAI 1 VPE 3 C,!,' N20' 9.., ")L"Ar 17 k b PR,0i K F rz 1>-i_3 <br /> 21 .#..5 Nf,d e..0&1 - P500(400G),20,18;FG) 0,1£"w s ir"PP0S 6&1AT$:�prw <br /> S <br /> { <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of.Consent. <br /> 'I certify,that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(f I am,a small_quantitygenerator)is true. <br /> Generator's/Offeioes Printed/Typed Name', t,; Signature I Month Day Year <br /> J 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> Ll 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> Cn <br /> Q Transporter 2 PrintedfTyped Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type yp ❑Residue El Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />
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