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Environmental Health - Public
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545431
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Last modified
3/9/2020 2:42:55 PM
Creation date
3/9/2020 11:51:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545431
PE
3528
FACILITY_ID
FA0005191
FACILITY_NAME
FULLER MOBILE HOME PARK
STREET_NUMBER
365
Direction
E
STREET_NAME
LOUISE
STREET_TYPE
AVE
City
LATHROP
Zip
95330
APN
19627022
CURRENT_STATUS
02
SITE_LOCATION
365 E LOUISE AVE
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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PART III; HANDLING METHOD <br /> Check the appropriate Unes. More than, one line may apply. <br /> 1. The RCRA waste identified above must be handled in <br /> accordance with the EPA Land Disposal Restriction <br /> Notification included on the reverse side of this form. <br /> 2. Recycl in,g. <br /> 3 . The waste identified above must be treated to meet the <br /> applicable standards in CCR} Title 22, Division 4.5, <br /> Chapter 18, Article 11 . <br /> 4. The waste identified above meets the applicable treatment <br /> standard. "I certify under penalty of law that i <br /> par8onall,y bave examined arta am familiar with the waste <br /> through analysis and testing or through knowledge of the <br /> waste to support this certification that the waste <br /> complies with the treatment standards specified in CCR, <br /> Title 22, Division 4.5 , Chapter Ig_ Article ll. I <br /> believe that L<i,s i.iivLmul.a.vix I su=itted is true, <br /> accurate, and complate. I am aware that there are <br /> significant penalties for submitting a false <br /> certification, including the passibility of a fine and <br /> imprisonment." <br /> 5 . The waste identified above is subject to a variance. the <br /> expiration date of the variance is Find and <br /> insert the actual prohibition effective date from Part IT <br /> above. <br /> .6. The Non-RCRA waste identified above is not currently <br /> restricted from land dispersal. <br /> PA,,RT IV: GENERATOR CERTIFICATION <br /> I hereby certify that all information supplied above and on all <br /> associated documents is true, complete and accurate to the best of <br /> my knowlede and that no omissions or errors exist. • <br /> Si poli t uucq <br /> p f <br /> 9� <br /> Print of type name: Algerle- <br /> oo, <br /> Title: <br /> V •d 'ONI 'AHM HOZ1-A WeillI L66l—Z4-9 <br />
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