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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0001963
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
12/19/2019 11:02:56 AM
Creation date
12/19/2019 10:33:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0001963
PE
2950
FACILITY_ID
FA0003965
FACILITY_NAME
PG&E
STREET_NUMBER
4040
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95204
APN
11702001
CURRENT_STATUS
01
SITE_LOCATION
4040 WEST LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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INC- <br /> TO BE USED FOR: NON-HAZARDOUS 1f A 3TE3 I`,`i. J LAA!/- <br /> GENERATOR: WASTE TO BF nISrOSED: <br /> NAME: PACIFIC GAS & ELECTRIC Co. TYPE: NON IiA%,r JZLv ?ClS Solit <br /> ADDRESS: 4040 WEST LANE ---- -- - _-.- . <br /> SITE LOCATION:-4040 WEST- DANT✓_, STOCKTON , CA_ <br /> CITY,STATE,ZIP: STOCKTON, C-A95204 SPECIAL HANDLJNG INSTUCYT..ONS: NONE <br /> PHONE:_' 209/263-5212 GLOVES G0GGL S OTHI'R <br /> EPA ID: CAD981390073 -- <br /> SIGNATURE OF AUTHORIZED AGENT: QUANTITYFBI•S>__ GAJ-__ YDSZff TON 3 <br /> D I S I GNATED FAC I I-I TY : RELEASE # 12622 <br /> DATE:r _ _ NAME:_G.I.B SCSI I_L _&_..REF I F I NG <br /> ADDRESS : _CGNIMEF_t{.: I FAL DRIVE - <br /> THE GENERATOR CERTIFIES THAT CITY , STATE, Z IP LNAK _RSI±I is_LD1_ CA 93308 <br /> THE WASTE AS DESCRIBED PHONE : _ I3051.3?7__U }13. <br /> IS 100% NON-HAZARDOUS EPA ID: CAD98088 '177 <br /> TRANSPORTER: TAG# :� UP I T NO. <br /> NAME: STAMCO, INC. PICKUP <br /> ADDRESS: P.O. BOX 1.50 <br /> CITY ,STATE,ZIP: SAN MARTIN , CA 95046 NOTE: THIS FOF!,J IS TO BE USED IN LIEU OF <br /> PHONE: 408/268-1196 •, THE CALIFORNIA I)EPARTMENT OF Hi?ALTII <br /> EPA ID: CAD063547996 SERV ICES HAZARD('I3S WASTE MANIFT?ST <br /> SIGNATURE OF AUTHORIZED AGENT: FOR NON-HAZARDOUr WASTE ONLY . <br /> DATE r <br /> THIS SECTION TO BE COMPLETED BY DIS.�L')EAL F'ACILI-1- <br /> DISPOSAL FACILITY : <br /> 14 AME: QUANTITY RECIEVED:_ _ <br /> ADDRESS: BBLL -_- Gi.� DS TONS <br /> CITY, STATE,ZIP : <br /> PITONE: ---- TIME: __----._.- IA.1 P'.. <br /> DISP. TICKET # <br /> IGNATURE: — 1 I CF'OSAI: mil—TK—'D7 <br /> DATE : ��-- SURFAC;1 Ir" OU 1DAii i <br /> -- LANDP'1 :.L <br /> _ irlJE"'TIUN <br /> OTHER <br /> RETURN COPY TO: GE3 GRATu; UNE_Ew° s ;F SPECIFIED <br /> NOTE: IT IS NOT AF'iY T 0 "i '„1x-.a'� l C <br />
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