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ARCHIVED REPORTS_XR0005829 CASE 1
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0545951
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ARCHIVED REPORTS_XR0005829 CASE 1
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Entry Properties
Last modified
9/24/2020 3:21:27 AM
Creation date
8/6/2020 11:09:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005829 CASE 1
RECORD_ID
PR0545951
PE
3528
FACILITY_ID
FA0003612
FACILITY_NAME
Yosemite Avenue Arco AmPm
STREET_NUMBER
1711
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
Ave
City
Manteca
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
1711 E Yosemite Ave
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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NOWHAZAR SPECIAL WASTE04013ESTOS MANIFEST <br /> 1 ; <br /> If waste Is asbestos waste,complete SeC tgns I,11,III and IVZI N wrO <br /> If waste is NM asbestos waste,complete only Sections 1,II and III ■ <br /> ;Am, <br /> a. Generator Name 1Lp S CON PANY b Generating Location ARM 8TRTION #06020 <br /> c Address PCs 9077 d Address 1711 E. Y097MM <br /> BUM PAIN, CA 9922-5077 !'A "Em, CAS <br /> f e Phone No 4 923) 299-8891 PAUL SUI"X N/A <br /> f Phone No <br /> If owner of the generating facility differs from the generator,provide <br /> AAOD PM)UM, t�AIgY Saltie ate I(e) <br /> g Owner's Name h Owner's Phone No <br /> c �► a a � o -5 112M oz ago TYPE <br /> I BFI WASTE CODE [0 <br /> DM-METAL DRUM , <br /> S SOIL DP -PLASTIC DRUM <br /> j Description of Waste8 -BAG <br /> k Ouanti Units No TYPE BA -6 MIL. PLASTIC BAG <br /> U t? 10 a 0 1 or m T -TRUCK <br /> 0 -OTHER WRAPIt <br /> GENERATOR'S CERTIFICATION I hereby car*that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state Jaw, has been properly described Classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations,AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has beefn treat in accordance wqh th r uir merits of 40 CFR Part�268�trid is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 26iZr ,.tC@ �*, Q,r �`a 4 Y' -CUBIC YARDS <br /> PATRICIA DIIjARD/ rin j l t) xuv. 161-51 <br /> 10 -OTHER <br /> Generator Authorized Agent HamaSignature Shipment Date <br /> YTRi4NSP��RTER, Oen e�ratoi�,cornplete'a I II3onrti etetm �� 3 � T <br /> Kr <br /> T NSPORTER I TRANSPORTER H <br /> a Name <br /> -h-Name - <br /> b Address it i Address <br /> 31 <br /> c Driver Name(Title -- - f-— - - - _ j Driver Name/Title <br /> P!T/rYPE <br /> d Phone_N — -Truck PRINT/TYPE <br /> � <br /> I Truck No <br /> f Vehicle Uoense No,/State m Vehicle LJCense No(State <br /> Acknowled ent of Receipt of Matenals Acknowledgernent of Receipt of Matenals <br /> S - Le 151 n <br /> Driver <br /> srje=Data <br /> Driver rydura Std Date <br /> mi"IMPRE <br /> .� ,_ �i <br /> a Site Name c Phone No <br /> b Phybical Address d Mailing Address <br /> • 4 <br /> a Discrepancy IndlQaltion Space <br /> 1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and <br /> am 1007/107 <br /> f F(W 09-31396 <br /> Narm d AWrorizsd Agent SOMA- <br /> Receipt Des <br /> a. Shippers's"Name b Shi <br /> PPers's"Phone No <br /> c Shippers's"Address <br /> Y s <br /> d Shippers's Special Handling Instructions and additional information <br /> CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packs <br /> lM <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicabra4riternational and national governmental regulations <br />
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