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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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NON-HAZARD. ,US SPECIAL WASTE & �_313ESTOS MANIFEST <br /> l <br /> If waste Is asbestos waste,complete Sections I,II,III and IV N o.51 2 4 <br /> If waste is j_QT III <br /> asbestos waste,complete only Sections I,Ii and <br /> Y � <br /> Generator Name JUM PAODL#G1'8 CCO@A14Y b Generating Location Alm 8'+l "ON 106020 <br /> c Address POE SO" d Address 1711 E. 7f'OSFmMI <br /> BUSM PARK: CA 90622-5r777 xhwE A, CA <br /> e Phone No (925) 299-8891 PAUL SUPPLE f Phone No <br /> owner of the generating facility differs from the generator,provide <br /> Owners Name ARCO PMXMTS C`APAl'tY <br /> h Owners Phone No Samo an i(e) <br /> BFI WASTE CODE S 1 2 9 I- <br /> q2 [Q S (} IYP-E <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> Description of Waste NO1*_"AZAR> SOIL k Quanta 8 -BAG <br /> Units No TYPE 8A -6 MIL PLASTIC BAG <br /> or d t7 0 0 1 T -TRUCK WRAP <br /> • <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or <br /> arty applicable State law, has been property described, classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> U ITS <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 /> ReStfic"Orls,I certrty and warrant that the waste has been treated in accordance with the requirements of 4t}CFR Pail 268 and is no longer a <br /> hazardous waste as defined by 40 GFR Part 261 At the,r 9 M' -CUBIC METERS <br /> i ARCO C70Mt?A[+iY Y3 -CUBIC YARDS <br /> WI6" Du.LMW Em IRCIN i 1 ' �'� � O -OTHER <br /> Generator Authorized Agent Name Signalure <br /> Shipment Date <br /> 0 <br /> ' !�r�,TRANSPORTER' ,pip (y ate k d+ Transjwrtera nom tetµe� <br /> r�COmpleta a1! `Trans <br /> TRANSPORTER I TRANSPORTER II <br /> Dim DII.f 11RD I:kG, IE,C. <br /> e POS 579 h Name <br /> b Address <br />' BMW* C& 945).4 i Address <br /> c Drlverlilame/Title } 1 IQ <br /> D <br /> #925) 634--6854 PRINT"" G 1 river Ivame/T)tle <br /> Phone No a Truck No — ! iME <br /> }� _ k Phone No I Truck No <br /> Venicle License Nolstate � �rj s <br /> r m Vehicle License No./State <br /> In o F,e;1 I f Materials Acknowledgement of Receipt of Materials <br /> 15-1 <br /> n LL 1= <br /> ShIMent DaW Drivers nedrrs Shipment Date <br /> N0 �� <br /> rte Name <br /> an D �' ><.Wt IMLL c Phone No (925) 447-0491 <br /> Physical Address 4002 no VA80D I o&D' 4001 fir. VASCO R0hD d Mailing Address <br /> I`IVERAIMr CA 94550 LIVERHOREa Ch 945SO <br /> i Disprepancy indication Space <br /> hely certify that the above named material has been accepted and,"e <br /> to the best of my knowledge the foregoing Is true and accurate <br /> -� JOB# 1007/107 <br /> dAsatiorized Agent nature POI 00-31398 <br /> Receipt date <br /> .,�x <br /> a <br /> pen3�s*Name <br /> b Shippers's"Phone No <br /> thipperMs*Address <br /> ShipperMs Special Handling Instructions and additlonaf Information <br /> Led, <br /> IFICATI(I Ierebydecare that the contents ofthis consignment are fully and accurately described above by proper shipping name and are classdiedPackaged <br /> and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />
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