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WORK PLANS_FILE 2
Environmental Health - Public
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5491
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3500 - Local Oversight Program
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PR0545028
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WORK PLANS_FILE 2
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Last modified
12/6/2019 4:58:58 PM
Creation date
12/6/2019 2:58:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
FileName_PostFix
FILE 2
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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POTRERO HILLS LANDF L.i_, INC. <br /> waighed at: <br /> POTRERO HILLS LANDFILL, INC, <br /> P.O. Box 68 <br /> FAIRFIELD, CA 94533 <br /> Deputy: Janea Quinonaz <br /> Deposit: Janes Quinonez <br /> BILL TO: 1754 <br /> DILLARD ENVIRON. SERVICES <br /> Vehscle Uâ–º: <br /> Reference: <br /> Grid: 14 <br /> DriverOn?: N <br /> Route: 305 <br /> -1'RLR/LP1l: VP72603 ' <br /> Origin: BANTA <br /> DATE IN:. 07/05/2013 TIME IN: ,10:11:52 <br /> DATE OUT: 07/05/2013 TIME OUT: 11:19:20 <br /> INBOUND TICKET Number: 01-383977 <br /> SCALc 1 GROSS WT. 62120 LB <br /> SCALE 3 TARE WT. 44260 LB <br /> NET WEIGHT 17860 LB <br /> Qty Descrwlon Amount <br /> 8.93 Clean Dirti/Tun-ADC <br /> i:.._ <br /> WE1"ASTH.CERT#FICATE: <br /> THIS IS TO CERTIFY that the tollowing <br /> described cominodity was weighed, <br /> measured, or counted by a weighwaster. <br /> whose signature Is on this certificate. <br /> who is a recognized authority of <br /> accuracy, as prescribed by Chapter 7 <br /> (commencing with Section 12700) of <br /> Divi';ton 5 of GaliFarnia Business <br /> and Professions Code), administered by <br /> the DlYision of Measurement Standards <br /> of the'Val'ifornia Department of Food <br /> and Agriculture. <br /> (Deputy Signature) <br /> This Is to certify that this load.does <br /> not contain any hazardous materials. <br /> medical waste or liquids of any type. <br />
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