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ARCHIVED REPORTS_REMEDIAL ACTION DOCUMENT
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WILLOW GLEN
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13751
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2900 - Site Mitigation Program
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PR0009025
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ARCHIVED REPORTS_REMEDIAL ACTION DOCUMENT
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Last modified
5/19/2021 2:55:48 PM
Creation date
5/19/2021 12:15:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
REMEDIAL ACTION DOCUMENT
RECORD_ID
PR0009025
PE
2960
FACILITY_ID
FA0004055
FACILITY_NAME
LATHROP GAS DEHYDRATOR
STREET_NUMBER
13751
Direction
S
STREET_NAME
WILLOW GLEN
STREET_TYPE
RD
City
STOCKTON
Zip
95206
APN
19105010
CURRENT_STATUS
01
SITE_LOCATION
13751 S WILLOW GLEN RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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❑ Keller Canyon U Ox Mountain Ll Newby Island ( Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill i Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)72671819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 'Pacific Getz&:Flcctric <br /> MAILING ADDRESS <br /> Beale Ueet TMa Code B24A_ �'114- <br /> CITY;STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> mflG +7, --94105 <br /> PHONE U GLOVES Q GOGGLES 0 RESPIRATOR Q HARD HAT <br /> E= <br /> °` - Q TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> 'y SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZE GEN /TITLE DATE <br /> GENERATOR'S CERTIFICATION:I herebythat <br /> of the above named material is not hazardous <br /> Waste as defined by 40 CFR Part 261 or title the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AN0.If tha Waite Is a treatment residue of a previously restricted hazardous waste <br /> subiiql tgidw Und'pis opai Restrictions.I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> Ta000tdanca with ilia te>jirirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> + '40C R'ParY261'_. . <br /> `¢ WASTE TYPE: <br /> r DISPOSAL Q SLUDGE <br /> ONSTRUCTION Q WOOD <br /> DEBRIS U OTHER <br /> Y ` U SPECIAL WASTE <br /> GENERATING FACILITY <br /> a <br /> &S. OIMoon �.i4t11iYfp <br /> y <br /> RA( R' <br /> NOTES: <br /> <br /> ADDRESS <br /> 3. 2 T_=M=L- "L <br /> CITY,STATE,ZIP <br /> Wi n&or, CA 95492 <br /> PHONE END MP BOTTOM DUMP TRANSFER <br /> :- 7`iR-1R_1 407 ❑ ❑ <br /> SIGNATURE OFATHORIZED AGENT O RIVER DATE ROLL- FF(S) FLAT-BED VAN DRUMS <br /> r' ❑ ❑ ❑ ❑ <br /> ' CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> Q <br /> EMARKS SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> Q ASH <br /> U SPECIAL OTHER <br /> SCHEDULING-MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST'# / n j A <br />
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