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3500 - Local Oversight Program
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PR0545872
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Entry Properties
Last modified
7/21/2020 3:38:54 PM
Creation date
7/21/2020 3:27:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
RECORD_ID
PR0545872
PE
3528
FACILITY_ID
FA0025947
FACILITY_NAME
JAYS MINI MART
STREET_NUMBER
3302
Direction
N
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95204
APN
11705037
CURRENT_STATUS
02
SITE_LOCATION
3302 N WEST LN
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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E <br /> EnviroPaciarc s <br /> PA.Box 1053,Vacaville,CA 95686,(707)447-2108 <br /> GEC I:r-No.A-876019 <br /> i <br /> NON-HAZARDOUS WATER DISPOSAL DOCUMENT <br /> GENERATOR SITE i <br /> 1 <br /> Name; Jay Mcltrath Name: Jay's Mini Mart } <br /> Address: P.O-Box 325,Stockticn,CA 95201 Address: 3302 West.Lane,Stockton,CA II} <br /> Contact: Jay Mcllrath Tet (209)462-8707 Contact John Selimen Tek (209)579-2221 <br /> CUSTOMER <br /> Name: ATC Associates Inc. Contact John Seltrnan TeL {209)579-2221 <br /> Address: 1117 Lone Palm Ave.,Ste B,Modesto.CA 95351 P.N. 54.26874.0001 <br /> , <br /> E <br /> E <br /> i <br /> DESCRIPTION <br /> Description of water monitoring well purge water <br /> Quantity: units: drums <br /> I <br /> This non-hazardous waste water Is monitoring well purge water,auger finale,sampling equipment Onsets,tank rinsate, combination there l <br /> of,or as described above. Described water may contain hydrocarbons.I certify that the above named material has been properly described , <br /> and classified according to applicable regulations,and possesses no characteristics that would require tts handling as a hazardous waste. <br /> E <br /> Ge neratortAuthorizedAgent: fJll� Or Y I <br /> �� Inrr '� <br /> Fdrd arruert/v+}tn si Dam <br /> TRANSPORTER DISPOSAL FACILITY <br /> Name: Enviro Pacific Name: Instrat <br /> Address: P.O.Box 1053,Vacaville,CA 95695 Address: 1105 C Airport Road,Rio Vista,CA <br /> Phone: (707)447-2106 Phone: (530)753.1829 j <br /> Prof. No. 316 Tracking No. Treatment; GAC <br /> { <br /> i <br /> Drivar. 02-1-710 <br /> Remava 0 <br /> i <br /> CERTIFICATION j <br /> THIS IS TO CERTIFY that the non-hazardous water described above will be treated and disposed at the above referenced disposal facility <br /> in accordance with applicable Federal,State and Local regulations. i <br /> R :oFive rized Brennan Mahoney Q'Z[-710 <br /> i <br /> s <br /> i <br />
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