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CORLW5SRC (2)
EnvironmentalHealth
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2500 – Emergency Response Program
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CORLW5SRC (2)
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Last modified
2/8/2022 3:19:52 PM
Creation date
2/8/2022 3:16:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CORLW5SRC
PE
2546
FACILITY_NAME
PORT OF STOCKTON
STREET_NUMBER
2201
Direction
W
STREET_NAME
WASHINGTON
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
NEAR14503001
ENTERED_DATE
7/20/2020 12:00:00 AM
SITE_LOCATION
2201 W WASHINGTON ST
RECEIVED_DATE
7/20/2020 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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\f aros Environmental Services <br />RECO 1515 South River Rd. <br />West Sacramento, CA 95691 <br />JUL 7 2020 (916) 371-5747 2 <br />CAD044003556 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT SERVICE ORDER <br />BILL OF LADING <br />SERVICE <br />ORDER NO. <br />JOB NUMBER NUMBER <br />GENERATOR GENERATOR EPA # <br />BILLING ADDRESS ;11 -C • <br /> <br />/• AMOUNT --1(:).:.,-,•-• ---' AMOUNT (IF AN <br />GENERATOR CONTACT ;1",--i-:/-Z . CHECK NUMBER <br />„ <br />PHONE , - - ) c .:: r : - <br /> <br /> :-: " ; ! I (:: - . . 5 PO. NUMBER <br />_ <br />JOB SITE ADDRESS CASH RECEIVED (amt.) <br />HALIDES <br />JOB DESCRIPTION <br />MATERIALS <br />START TIME <br />NON RCRA HAZARDOUS WASTE LIQUID, (USED OIL) CODE # <br />ARRIVE TIME <br />NON RCRA HAZARDOUS WASTE. SOLID - LIQUID CODE # <br />LEAVE JOB <br />U.S. DOT DESCRIPTION: STOP TIME <br />(USED ANTI-FREEZE) NON RCRA HAZARDOUS WASTE LIQUID CODE USED OIL FILTERS DRUMS <br />MANIFEST NO. ' NO. OF GALLONS <br />t DRIVER'S SIGNATURE <br /> <br /> TRUCK # — -- <br />DESIGNATED TSDF: RAMOS ENVIRONMENTAL SERVICES. 1515 SOUTH RIVER RD. WEST SACRAMENTO 95691 CAD 044003556 <br />I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE, AND THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M. <br />This is to certify that the above named articles are properly classified, described, packaged, marked and are in proper condition for <br />transportation, according to the applicable regulations of the Department of Transportation. <br />Generator's Certification: I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />to be economically practicable. Ramos agrees with the generator to send all their hazardous waste to an authorized hazardous waste treatment facility <br />via Ramos' standardized permitted storage facility. <br />All used oil collected from the generator listed above will be transported only to a facility permitted by the State of California to accept used oil. <br />Terms - net 15 days. <br />After due date, a finance charge of 1.50% per month, 18.00% annual rate, will be charged on the unpaid balance. The customer agrees to pay reasonable <br />costs and attorney fees incurred in the collection of this obligation. Venue for purposes of enforcement of this obligation shall be Yolo County. <br />I declare, under penalty of perjury that the foregoing is true and correct. <br />GENERATOR SIGNATURE <br />24 Hour Emergency Response Team: 1-800-456-7745 <br />DATE <br />I I <br />1 I
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