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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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BRUELLA
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2200 - Hazardous Waste Program
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PR0513856
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COMPLIANCE INFO_PRE 2019
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Last modified
2/7/2020 1:15:21 PM
Creation date
2/7/2020 11:42:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0513856
PE
2220
FACILITY_ID
FA0003795
FACILITY_NAME
LIBERTY RURAL FIRE DISTRICT
STREET_NUMBER
24124
Direction
N
STREET_NAME
BRUELLA
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00731024
CURRENT_STATUS
01
SITE_LOCATION
24124 N BRUELLA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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Attention: F'KEMOUW <br /> S.end Payment to: A�� � BILL OF LADING / INVOICE <br /> P.O. Box 2875 <br /> ' villeCalifornia 95696 Inv. # <br /> � j7)448-3700 <br /> (888) PUMP OIL SERVICES Date: <br /> (888) 786-7645 <br /> Pager: (209) 987-2188 L JJSPECIALIZING IN WASTE OIL RECOVERY <br /> Customer Information Ship To: EPA # <br /> Name: 5 D e J9 r / Name: B.C. S o1`ockl Distri1') iing <br /> Address: q!J�SO eC'o/��"C/� �vA� Address: 7300 Chevron Way <br /> City:�10 o State: C,1 . Zip: 9 z- o City: Dixon State: CA Zip: 95620 <br /> I <br /> WASTE MANIFEST GALLONS PER GALLON <br /> SERVICE INFORMATION CODE NUMBER QUANTITY PRICE AMOUNT <br /> Used Oil NOS Combustible, Liquid 3, UN 1270 221 <br /> Used Antifreeze Non-RCRA Hazardous Waste Liquid 131 <br /> IB�i�rirrBM <br /> Non-RC R arrdous Waste Liquid 22-/ <br /> Other: �C o.ti v .",` v2 N /A I /V 0V t" <br /> Test lam" Pass 3*" Fail ❑ PPM Lubricating Oil U- Industrial Oil ❑ <br /> REMOUW ENVIRONMENTAL SERVICES a�s • <br /> P.O. Box 2875 A 1.5% Late Payment Charge will be Total Charges i <br /> Vacaville, CA 95696 added to all balances not paid within <br /> EPA#CAD000160519 15 days of this invoice. <br /> D.T.S.C. #3544 <br /> CA 132918 <br /> Driver's Signature Ge erator's Signature <br /> ADDITIONAL INFORMATION <br /> Customer Billing Name 5%, f) <br /> Customer Billing Address q p, City /ir- M 0 Col. Zip v <br /> Customer Phone Numbers (Zp ) 3 e,7 _d -I ) O <br /> Customer Purchase Order Number <br /> Customer E,P.A, # <br /> Dtes: <br />
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