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COCUSD0M0
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ROTH
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1012
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2500 – Emergency Response Program
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COCUSD0M0
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Last modified
3/21/2023 2:25:44 PM
Creation date
3/21/2023 2:21:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COCUSD0M0
PE
2546
STREET_NUMBER
1012
Direction
E
STREET_NAME
ROTH
STREET_TYPE
RD
City
FRENCH CAMP
Zip
95231
APN
19820016
ENTERED_DATE
4/21/2022 12:00:00 AM
SITE_LOCATION
1012 E ROTH RD
RECEIVED_DATE
4/18/2022 12:00:00 AM
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\bmascaro
Tags
EHD - Public
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Consignee: Crosby & Overton, Inc. <br />Manifest NumberC)J1 i 4-2 Line Item Number (9b) <br />Number of Containers be' weighed <br />12 ptSignature of Weighmaster <br />Date <br />L <br />WEIGHMASTER CERT1FICAT <br />CROSBY&OVERTON,INC. <br />ENVIRONMENTAL SERVICES <br />1630W. 17th Street • Long Beach, CA • 90813 <br />(562) 432-5445 <br />Weigh Ticket of Number 19 7 5 9 <br /> <br />WEIGHMASTER CERTIFICATE <br />Generator / Owner /Agent Name <br />TransporterC,r,:?5,3//(4,F,/-<.--2,-;,,LiVehicle License No. <br />Container Type M DF DW CF BA Triwall Tote Other <br />(circle one) <br />Description of Material / Commodity /— <br />C & 0 Document Number ? <br />THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted <br />by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, <br />as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California <br />Business and Professions Code, administered by the Division of Measurement Standards of the <br />California Department of Food and Agriculture. <br />Weighnnaster license No. 009152 <br />Comments: <br />Gross Only <br />301 lb <br />n j T <br />301 lb N <br />164 lb <br />0 lb T <br />164 lb N <br />nr=Pir.r: r.11PY
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