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REMOVAL_2007
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0527026
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REMOVAL_2007
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Last modified
4/28/2021 12:25:38 PM
Creation date
11/5/2018 12:57:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2007
RECORD_ID
PR0527026
PE
2361
FACILITY_ID
FA0018313
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15688
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620077
CURRENT_STATUS
02
SITE_LOCATION
15688 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
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FilePath
\MIGRATIONS\H\HARLAN\15688\PR0527026\REMOVAL 2007.PDF
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EHD - Public
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tlL/Lb/2tltly 15:36 916-373-1172 WALTON ENGINEERING PAGE e5 <br /> `• V Page 2 of 2 <br /> AWED WASH <br /> GENERATOR WASTE PROFILE SHEET continued <br /> Waste Profile# <br /> V. Physical Characteristics of Waste <br /> Characteristic Components "/o by Weight(range) <br /> I. R�, <br /> 2. <br /> 3. <br /> Color: Odor(describe): Free Liquids: "/o Solids: pH: F�1/as�Point: Phenol <br /> l o Wn1 SL/G� �rAS Content or®"/"O 90/0 N A;4L"P <br /> Attach.Laboratory Analytical Report(and/or Material Safety Data Sheet) <br /> Incladin Re aired Parameters Provided or this Pro rlt <br /> Docs this waste or generating process contain regulated concentrations of the following Pesticides and/or Herbicides: <br /> Chlordane,Endrin.Heptachlor(and it epoxides),Lindauc,Methoxychlor,Toxaphene,2,4-D, or 2,4,5-TP Silvm as ❑ YES or NO <br /> defined in 40 CPR 261.337 <br /> Docs this waste or generating proem cause it to c7 ceed OSHA exposure limits from high levels of Hydrogm Sulfide or <br /> H dro n 'de as dcEnedin 40 CFR261.237 ❑YES or®NO <br /> Does this waste contain regulated concettffations of Polychlorinated Biphenyls CBs)as defined in 40 CFR part 7617 YES or NO <br /> Dna this waste contain regulated concentrations of listed hazardous wastes defined in 40 t'FR 261.31,261.32,261.33, <br /> ineludin RCRA F-Listed Solvents? ❑YES or®NO <br /> DoHoes this waste contain regulated concentrations of 2,3,7,8-Tetrachlorodihcnzodioxin(2,3,7,8-TCCD),or any Other' <br /> as defined in 40 CFR 261317 ❑YES or f8 NO <br /> is this a regulated Toxic Material as defined by Federal and/or State regulations? YES or NO <br /> is this a regulated Radioactive Waste as defined by Federal and or State rc lations7 YES or NO <br /> Is this a regulated Medical or Infectious Waste as defined by Federal and/or Stater lotions?' YES or NO <br /> Is this waste eneratod at a Federal SuperRmd Clean U Site? YES or K NO <br /> VI. Generator Certification <br /> I hereby certify that to the best of my knowledge and belief; the information contained herein is a true and accurate description of the waste <br /> material being offered for disposal, t further certify that by utilizing this profile, neither myself nor any other employee of the company will <br /> deliver,for disposal or attempt to deliver for disposal any waste which is classified as toxic waste, hazardous waste or infectious waste, or any <br /> Other waste material this facility is prohibited from accepting by law. Our company hereby agrees to'fully indemnify this disposal facility against <br /> any damages resulting from this certiScation being inaccurate or untrue,I further certify that the company has not altered the form or content of <br /> this prefile sheet as provided by Allied Waste Industries.Inc. <br /> AUTHOR17ED R".rKratn IATIVE NAME ANA E(Printed) UkjMPANY NAME <br /> A TMORLMD RE ENTATTVE SIGNATURE DA <br /> VII. Allied Waste Decision <br /> Approved FIRejected Expiration: <br /> Conditions: <br /> Name Title Signature Date <br /> 9E Allied Waste.August 2000 <br />
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