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CO0041579
Environmental Health - Public
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2500 – Emergency Response Program
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CO0041579
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Last modified
7/2/2020 11:23:45 PM
Creation date
2/11/2019 10:41:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0041579
PE
2546
STREET_NUMBER
1990
Direction
N
STREET_NAME
PICCOLI
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
10121001
ENTERED_DATE
5/23/2016 12:00:00 AM
SITE_LOCATION
1990 N PICCOLI RD
RECEIVED_DATE
5/23/2016 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\P\PICCOLI\1990\CO0041579.PDF
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EHD - Public
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ENVIRONMENTAL <br /> A1.111-10RIZ.ATION —0111111 -PARTY WAOIS IMOVIl rpt <br /> May 25,2016 <br /> Note:This authorization is only valid for I year from the above date. <br /> To Whom It May Concern: <br /> Please be advised that the following company and/or individual has been appointed to work as our agent foe purposes <br /> of managing waste materials that we may generate. <br /> Name of Authorized Agent Title <br /> Jennifer Hobbs Profiling <br /> Name of Authorized Company Telephone Number <br /> K-VAC Environmental Services,Inc. '510-506-1178 <br /> The above broker/individual is authorized to act as our authorized agent for the following purposes: <br /> Profile waste characteristics of specific wastes generated by us and complete and certify Generator Waste ptnfile <br /> Sheets, <br /> f <br /> Sign contracts to dispose and/or transport materials/wastes, <br /> P <br /> Provide supplemental information and sign certifications necessary to comply with the disposal facilities approval <br /> requirements. <br /> Sign manifests to initiate shipment to disposal facilities. <br /> I agree to provide the authorized agent with any specific generator knowledge of processes generating waste as is <br /> necessary for the agent to adequately profile generated wastes. Our anthodzed agent will notify us prior to any action <br /> stated above,and will provide us with copies of any documents bearing our name. <br /> Name of Company Generating Waste Mailing Address <br /> nl- <br /> 4enencoe Contact(Print) 'l'idc <br /> Signature Telephone Number <br />
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