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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,. VS SPECIAL WASTE & 313ESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections I,A,III and IV <br /> ` If waste is NQT asbestos waste,complete only Sections I,U and III N o S 122 4 9 <br /> 7 � F ns <br /> e Generator Name ARES b Generating Location AV= MnO" #06020 <br /> c Address POB 5077 IL712 E. M <br /> d Address <br /> BU=Vk paRY. CAN 90622-5077 !'lllNPUA, CA <br /> e Phone No (925) 29 ``8891 PAWL SuppLE f Phone No N/A <br /> If owner of the generating facility drffers from the generator,provide <br />'g Owner's Name ARCA PMXX= home" Sarin as I <br /> h Owners Phone No <br /> 1 BFI WASTE CODE C a 9 0 2 0 5 iYPEl i3 `� Mi] <br /> Containers DM-METAL DRUM <br /> ZABDe�Cf>$ S0� BP _G <br /> PLASTIC DRUM <br /> Description of Waste k Ouant Unds No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> ET -TRUCK WRAP <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named matenal is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law, has been properly descnbed, classified and packaged.and Is in proper condition for transportation according to <br /> applicable regulatbns,AND,it the waste p POUNDS <br />' la a treatmerit,residue of a previously testricted hazardous waste subject to the Land Disposal <br /> Restrictions,I certify and warrant that the waste has bean treated in accordance with the requirements of 40 GFR Part 268 and Is no longer a Y -YARDS <br /> hazardous waste as defined by 40 CFR Part 261 M' -CUBIC METERS <br /> �� <br /> ��7""�� g�! �G'l`S ' Y3 -CUBIC YARDS <br /> FAIR;CIA PWJJ R0/ VUJ ARD =V0 �'� •�; ? 1 O -OTHER <br /> Generator Authorized Agent Name Signature y f Shipment Date <br /> TrAn <br /> NSPO + 0 1 8n8 sL`•`� l e i "f""`a' let � t y -. 11ZF 4 li <br /> TRANSPORTER I TRANSPORTER 11 <br /> ame ,^ ` - t h Name <br /> b Address h' '_ 1 > 'l <br /> t r Address <br /> c Dever Name/Title �- '' r '' rr ��: � <br /> '' j Driver Name/Title <br /> J `PRINTMME <br /> � ��/ � (r � �x � �S PRINT/TYPE <br /> Phone No <br /> e Truck No k Phone No I Truck No <br /> Vehk:!q LIc ame No./State `�I �� > f'1•.1> , -s <br /> m Vehicle License No/State <br /> Adciowledgement of Receipt of Materials Acknowledgement of Receipt of Matenals <br /> j ff <br /> r <br /> oioer n <br /> Shir Date Ddwr S neWea Shi bars <br /> ?i <br /> Site Name 8PI i VAS � ED SA411WARY L KILL 925 407-0491 <br /> c Phone No <br /> b Physical Address 4001 no VA900 ZED 4002 IPI. VAb1Cp T AD <br /> ��, CA �S� d Mailing Address <br /> L2VZRHORZa CA 94550 <br /> e Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate <br /> JC" 1007/107 <br /> f Nams d,►ichoiwso Agerd PO* 09-31398 <br /> telpt Date <br /> Name <br /> rShI <br /> b Shippers%*Phone No <br /> ppers"s*Address <br /> d Shippers's Special Handling instructions and additional Information <br /> rrk's'd <br /> eby decibre that the contents of this consignment are fully and accurately described above by proper shipping name and are classifted, pa <br /> ,and labeled/placarded,and are In all respects in proper condition for transport according to applicable International and national governmental regulations ckagE <br />
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