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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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EHD - Public
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El Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,.CA 94565 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 <br /> Phone(209)982-4298 <br /> -9891 9183Fax(925)458 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GEN MATgn WASTE ACCEPTANCE NO. <br /> i at s tte. av an. <br /> MAILING ADDRESS t <br /> Beale Street e B24A Its it_r_ <br /> IV,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ;�F► ra»Ojarri7 (-'A O GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 41 j 913-3113 O TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> R.obmt Gray <br /> a <br /> SIGNATURE OF#UTHOED AGENT/TITLE DATE <br /> r <br /> t GENERATOR'S CERTIFICATION:1 he by rtity that the above named material is not a hazardous - - <br /> waste as defined by 40 CFA Part 261 or 2 of the California code of regulations,has been properly - <br /> described classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> - regulatlons,;AND,If the waste Is a treatment residue of a previously restricted hazardous waste - <br /> subje.d tithe Land Disposal Restrictions,1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> !' accoidarlce. w th-the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR art 261. <br /> WASTE TYPE: <br /> ' <br /> ACI.DISPOSAL 0 SLUDGE <br /> Y. <br /> O:CONSTRUCTION O WOOD <br /> g ❑DEBRIS ❑OTHER <br /> O-SPECIAL WASTE <br /> GENERATING FACILITY <br /> >~athrop Dehydrator. Statim. i4vop <br /> w ^• °_ER NOTES: "VEHICLE LICENSE NUMBER ' TRUCKNUMBER <br /> eS raWp0 o_n <br /> ADDRESS - �( <br /> CITY,STATE,ZIP <br /> Windsor, CA 95492 <br /> HONEI END MP BOTTOM DUMP TRANSFER <br /> "707)838-14,107 <br /> ❑ ❑ <br /> CIGNA UR OF AUTHORIZED AGENT OR DRIVER DATE ROL -0FF(S) FLAT BED VAN DRUMS <br /> ,7 <br /> Zn1_ ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> O SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL a 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# g g l Q n 4 <br />
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