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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2200 - Hazardous Waste Program
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PR0521322
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
10/28/2021 10:03:22 AM
Creation date
10/21/2021 2:19:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0521322
PE
2220
FACILITY_ID
FA0010932
FACILITY_NAME
AutoZone #5682
STREET_NUMBER
1300
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
Ln
City
Lodi
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
1300 W Kettleman Ln
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 121.Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL000288559 2 007771904SKS <br /> 24.Generator's Name <br /> Autozone# 5682 <br /> U.S.EPA ID Number <br /> 25. Transporter 3 Company Name Clean Harbors Environmental Services,Inc. MAD039322250 <br /> Number <br /> 26. Transporter 4 Company Name Tri State Motor Transit MOD095038998 <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> O <br /> W <br /> z <br /> W❑ <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 3 Acknowledgment of Receipt of Materials <br /> 11-- Printed/Typed Name Signature Month Day Year <br /> W Morris Rasciner Morris Rasciner 11 20 2020 <br /> O <br /> 0- <br /> zc* <br /> 34.Transporter 4 Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> jason p Jason p 12 04 2020 <br /> 35.Discrepancy <br /> J <br /> U <br /> LL <br /> G <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c� <br /> LU <br /> LU <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />
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