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COMPLIANCE INFO_2019
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PR0538350
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COMPLIANCE INFO_2019
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Entry Properties
Last modified
8/18/2020 10:17:26 AM
Creation date
7/9/2020 2:35:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0538350
PE
2220
FACILITY_ID
FA0012734
FACILITY_NAME
SAFEWAY STORE 1769
STREET_NUMBER
2808
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2808 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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Please print or l I y7yoe <br /> UNIFORM HA ]ARDOUS t . GmeratorlD Number 2 . Paget or E y yry-� Forrn Approved . OMB No . X511 -0039 <br /> WASTE MANIFEST CAR 000 247 213 2 ' 11101114M434T 1 4 . Manimst Tracking Np' 11695mne, <br /> ATTN ��"dBLVDG "201J9 `l U it YI� aft, 7 JJK <br /> ST Icer CA 95pa <br /> STOCKY N , <br /> 6 T his Pn (209) 491 - 5555 STOCKTON , CA 95204 <br /> fi . mnspwmrI Company Name <br /> EO INDUSTRIAL SERVICES US EPAID Number <br /> BEAD RO& INC . DBA TSMTCO MIK 435 842 742 <br /> U . S . EPA IO N ayor <br /> 43 <br /> 6 . Dmlwaked Farm r Name ane simAddress US ECOLOGY TULSA , INC . MOD 095 038 998 <br /> U S EPA ID Number <br /> 2700 South 25th WestAvenue <br /> TULSA , OK 74107 OM 000 402 398 <br /> cili s End (918) 5824595 <br /> 9a . 91) US DOTOomouon (intluaing Pmper Shroping Name , Han Class . IDNumb «, <br /> HM and PacNingGroUpfr nyt) 10 . Containers 11 . i01a1 12 . Unit <br /> I ' No , iYPa ouarm yp , ryU , 13 . Was Godes <br /> o 1 0001 D00 33 <br /> Swir <br /> Alcohol) , 3 , PGII , ( R0 : D018) , ERG 11128 . e . s . e ' <br /> P D001 DOt 003 <br /> 3 _ a uid , basic , IaOEganie , a . o . s . 001 pp am i 34 <br /> ( Solum Hydrouide , Potassium Hydros9de ) , S , PG Ii , ERG 01 00019 P D00 12 <br /> 4 _ 1 , Ste e , . i , 11 , RG 911 1 <br /> 001 DF 00001 P Po75 311 <br /> 1o1 .sMr � AM41gaa „ Ilt A . A9SM W73 / AgSMW13 - NICO7INEAN2 . A9SHNOl / ABSHN92 - F <br /> C1, l / 8S1M0 / ABSHNO - CORROSIVE BAS0 NICOTINE CESSATION PRODUUT7fUil � i <br /> 15 . GENERATOR ' SCIFFEROR ' SCERT! 11 111 Intrebydeadme Nat Necontenm 01 liscUmagnmentarefullym Ia [are dewan bad above bYtheprppershippingnal are Namifor packs <br /> marked and IabelMlpmpded aM are in all respects m proper corrosion farttranspon according toa <br /> EVwder, cemity Natthecontents of is consignment mimthetermsorta almcM1ed EPAAcknan partisawds al <br /> or Cu�se�� national governmental regulafons . ltexp « t sM1ipmerRaM am the Primary <br /> low " Nat Neimteminimen on ammment iderink In 40 CFR 262 . 2 ] ) a ) tit I am alame Uranatygen tutor) or <br /> Genwato /s /Odern Primes ?yped Name a @ ( ift am a small quantirygeneraror) is We . <br /> \L ) Slg mum <br /> - \ ✓ �� Q . � . I1 .L � <br /> s . Nlematinnal Shipments Mon D 1Y 1 19 <br /> i Trdnep « mr signalureduslimms only❑ ImpodroU ' S . ❑ Export kom U S Porlofmary/exn : _ <br /> 17 . Tr« epomer Acknowledgment of Receipt of Naturists Damm on VSUp <br /> . : <br /> t Riroad hoped Name <br /> i � I yam _ C Ignawre _ Mont Day Yew <br /> zTmnsp « hv2 Poil rye ONNam' 0 11 19 <br /> JV\ �i1V SO Mmt Day Year <br /> 1 <br /> 16 D� acrepanay 461 ` 6 <br /> 10a . Discrepancy Indiwlbn Space ❑ Duentity <br /> LJ Type DR due ❑ Partial Rejection ❑ Full RejeWon <br /> (` 10b . Nmfrete Faaary (or Generaar ) Menlfest Remrence Numder : <br /> U . S . EPA ID Number <br /> Fact " Prime : <br /> ow LL 16c . Signature OfAnwnata Facility for Gerare <br /> t«7 <br /> we It Mp N Day Year <br /> 0 tg Haramolmwmm Raped Management Me Up cpeea (I . a , eieppaal , aria recrntg anmmal <br /> t . H141 H141mm a . <br /> l H110 H141 <br /> 2d . Designama Eadfyanerpropemt«. c « fr�4ron m receiptot na :emopa mammals cpverea by Ina mamrmt except m r« ea <br /> PN Item tea <br /> nmeertvcea Name slgrmn , re <br /> CMoral Day Y <br /> EPA Form UAJ 2Z ( Rev , 12- 17 ) Previous ewas9aobsolete . <br /> D SIGNATED FACILITY TO EPA ' s e - MANIFES [ SYSTEM <br />
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