Laserfiche WebLink
13 <br />OMB#: 2050-0024 Expires 9/30/92 <br />/PROTECTION <br />ENVIRONMENTAL <br />... <br />T= Hazardous Waste Report <br />FORM <br />IDENTIFICATIOND <br />Ic <br />"RECEIVED <br />INSTRUCTIONS: Read the detailed instructions beginning on page 6 of the 1991 Hazardous Waste Report b T Lh <br />SEC. ISite name and location address. Complete items A through H. Check the box ® in items A, C, E, F, G , and H if same as label; if <br />different, enter corrections. If label is absent, enter information. Instruction page 6 <br />A. EPA 10 No. I G A� I B. County <br />sam. as label ❑ or —, D 0 6 3 0 3 6 7 7 6 San Joaquin <br />C. Site/company name Pacific Coast Producers D. Has the site name associated with this EPA ID changed sirice,21W <br />}❑ 1 Yes <br />-> fJ <br />Same as label ❑ or 7 2 No <br />E. Street name and number. ff not applicable, enter industrial park, building name or other physical location description. <br />Same as label ❑ 835 Stockton Street <br />or -0 <br />F. City, town, village, etc.rT��' G. Stats H. Zip Code 1� <br />Same as label ElLodi Same as label ❑ Same as label U <br />or - t�� 1_9 15 12 14 10 –1_ 1 1 1 1 <br />SEC. II Mailing address of site. Instruction page 6 <br />A. Is the mailing address the same as the location address? t Yes I SKIP TO SEC. 111 I <br />❑ 2 No (GO TOBOX B) <br />S. Number and street name of mailing address <br />C. City, town. village, etc. D. State E. Zip Code <br />I I I I I 1 I I I—t I I I I <br />SEC. III Name, title, and telephone number of the person who should be contacted if questions arise regarding this report. Instruction page 6 <br />A. Please print: last name First name M.I. B. Title C. Telephone <br />-% ers <br />Ron nistrative 21 0191 1 31 61 71— 1 81 81 01 01 <br />ManagerExtension I I I I I <br />SEC. N Enter the Standard Industrial Classification (SIC) Code that describes the principal products, group of products, produced or distributed, or <br />the services rendered at the site's physical location. Enter more than one SIC Code only if no one industry description includes the combined <br />activities of the site. Instruction page 7 <br />A. B. C. D. <br />1 3 14 11 11 1 t I I I I l I I I I I I I I I <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a <br />SEC. V system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person <br />or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the <br />best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties under Section 3008 of the <br />Resource Conservation and Recovery Act for submitting false information, including the possibility of fine and imprisonment for knowing <br />Please print last name First name M.I. B. Title <br />,SAi- NNkiP. AL 6 1 of <br />D. Date of signature n t , " , <br />MD. DAY YR. <br />EPA Form 8700-13A/B (Revised 8-91) OVER --> <br />