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COMPLIANCE INFO 2002 - 2017
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2200 - Hazardous Waste Program
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PR0514045
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COMPLIANCE INFO 2002 - 2017
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Entry Properties
Last modified
1/8/2019 2:43:09 PM
Creation date
12/6/2018 3:41:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2002 - 2017
RECORD_ID
PR0514045
PE
2220
FACILITY_ID
FA0006439
FACILITY_NAME
COUNTRY CLUB MOBIL CIRCLE K
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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WE ACCEPT VISA & MAS-IMI9CARU <br />NSA <br />P.O., Box 2407 UNION CITY, CA 94587-2407 P.O, Box 349 SILVER SPRIN08, NV 89429-0349 <br />(800) 499-3676 FAX (510) 476-1786 (775} 577.9001 ,FAX (775) 577-9199 <br />CAR 000 007 013 NVD 982 358 483 (800) 471-2105 <br />BILLING INFORMATION <br />J013 Sim <br />Bill of Lading <br />Invoice #19379( <br />Date —� <br />NAME _- <br />�^ <br />NAME <br />—�^ r <br />p0CASH CHECK <br />i1Db�RES <br />Kip-L�J�J 4i 1 � <br />ADDRESS // <br />5-- <br />�jt�,vf yi IJ' v� <br />CUSTOMER I=PA 117 � <br />r <br />PROFIt,L, fl <br />CITY f/ STATE �j ZIP <br />01 S ZIP <br />PFIONE NO. <br />307 <br />PHONE NO. <br />CUSTOMER ID A <br />PRODUCT. PROPER <br />'WASTE <br />. MANIFCST NUIVISE.R <br />QUANTITY <br />UNITS <br />PRICE <br />AMOUNT <br />SHIPPING DESCRIPTION <br />CODE <br />Used Oil, Nan-RCRA Hazardous <br />Waste, Liquid <br />229 - <br />Used Automotive Andfreeze, Non-RCRA <br />Hazardous Waste, Liquid <br />134 <br />Oily Water•Non-ROPA HazardoU's <br />�� <br />Q <br />Waste, Liquid <br />Nan RCRA Nazardauz Waste Solid <br />Oil Contaminated Debris / Soil <br />Waste combustible !Squid noS 3 <br />UN1993, PG III <br />Non I lazardous Waste L1 uid <br />Non Hazardous Waste Solid <br />Transportation Charges <br />Washout Charges <br />Drained Used Oil Filters <br />Empty Drums.. <br />(y <br />Additional Labor <br />Pressure Washer <br />others r ,, <br />G'lU <br />DISPOSAL/RECYCLING FACILITY: Co6ac8att Swllon lhduorlal Apripulture GOVe ont v-rthe TOTAL <br />Alvino Indopendant 011 r= Cl"Mulur I?svlrom11-3rua1 Mgmt, InC, ^� Svrnunc Water Tech <br />5002 Archer Street',. Alvlgo, CA 2430Alnwnd Dr. 5575 S. Doyle AVG; Veolon, CA, <br />CAL 000 t G1 %43; 95002 Silver spnngs, hV 89429 CAD 087 030 D93; 90068 <br />(61F4 47a-1740 M10082 358 483 (100) 288.7747 NET 10 DAYS <br />(773) 577.9001 <br />FaolPou Aacawry Resouruu $eopotT EnVltnnrnrultpl �� 4oninlarcttd Floor Ree rig <br />3i50 Pico Nvd: Lue Anpolos, CA 076 Svuoort Blvd; a"dwaod City. CA 3a=,9 Weatarth Avv: Unlon City, GA <br />CAD 008 252 40& H0023 CAR Goo 140 624; U4063 (51C) 4970'237; 94567 <br />(S50) 364.8154 <br />n <br />0,morm Kordoonomaby & ovonon <br />^000 rd• axn'Ada BIVtl: Compton, CA 1530 W, 17111 Strom; Lonp 9ear:b, CA - <br />CAT 080 013 353: U0222 I�SoCAP 028 4DJ 019; 60183 <br />(910) 5111.7100 <br />f heresy canity that oil intarmatlon dutrrni ted In thi, ana all uuaahad documents Contuih trUe end accurate daa^mptiona or lim w. oto. AN r avant 6,tarnitdlon re6ardk1tl known or �ucpeclod ha2ards <br />aeeociatud with It's q;b,, hac bean rlwctasad. I t we Play, an uetaWi-.hod otaVmm w roduee the voluniiI ut v+rw-to fir 81e eg n to be o w ally ora bla. <br />DRIVER GENERATpR <br />SIGNA'rUR i <br />SIGNATURE <br />7C •017 TTr]7 117 CTra <br />
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