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4700 - Waste Tire Program
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PR0522471
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Entry Properties
Last modified
3/22/2020 6:15:59 PM
Creation date
3/20/2020 9:13:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0522471
PE
4740
FACILITY_ID
FA0015291
FACILITY_NAME
EL CAMINO TIRES
STREET_NUMBER
2498
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
952056551
APN
15544005
CURRENT_STATUS
02
SITE_LOCATION
2498 E MAIN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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CField
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EHD - Public
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CBINornLa lntepnted Wast!Management Board <br /> .CA Comprehensive Trip Log and Receipts 10002 P.Ot 8-1259,Saaemento,CA 95812-1259 <br /> jElX1-A1M1P[LjEj 11.12131. Comprehensive TriNumber <br /> OWKBBM(llaa�INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE <br /> 3582822 <br /> BY alpning"'I.CA C—Pmnarnh•TdP Lop and Ramp,the elg—j,)r q0 em1 UN IManned—p Id•d an Nb form W11 W eo.• naa oaMld A ptopd N art baM•KM In—de—Mal TM•,14 CCP;5-0- <br /> 17011 N et0.,B•r•RuM 1•made for diad—W..Inn—Ion,In.CnVMB MD—n tM Mpnarlal W NN loan M M•"N"""end lelaphpr Romper poeld•d m DVe loan or raeNpi _ '.�, <br /> e "s e7 n ormat an Hauler Address F— a- <br /> Truck Decal Number Business Name <br /> Address E <br /> City, State and Zip Tire oi sp sal l Service <br /> License Plate Number State Pii Box 1035 Linden,CA 95236 <br /> Common (209)405-5675 <br /> MDR <br /> M ©® Carrier. <br /> I M MY YnUer Panary of perjury Temr dw bxs Wei•sura of CaM ,mat Ma Infam,a0on PmVld•d a—a u aue antl oortecl In atldltldn.I•rri IrvetMl W.IAnOl,1 eW I IbnnaWn mry rWUN F w nalnn,—b-m denial W mere1 W tM <br /> WaW TBe H-W Faglehal W W I P,Gk Retourua Code tetl n 429W arW may raeWl e,C penepaa up to f M.DDO W dry—A61. admMlabeWa Naa up IP 38,000 P•r P1olallon;W dry u dew10•d k Polk Ree—ea <br /> Goo•Lcean 4.. <br /> fy� �ir-r.�, <br /> G'Drlver's Name(print) /A'ver's Signature Date <br /> Comprehensive Trip Log i- <br /> Number •.. Information Facility Tire Program <br /> .a 3582822 C Pick Up El Delivery` <br /> I <br /> HauliiTlie`Piogiam I br`i- Sate SuffixFacility Telephone Number t <br /> DATE 00_/ 0[] `a <br /> /. � 1. r <br /> ooa-a�oaaoo <br /> 03 w 0 Whole Tire Court Weight in Lbs: <br /> .2 Facility.Business <br /> •y — r Volume Cubic Yds.a Weight in Tons Name/Address <br /> City,State and Zip ` <br /> o 'Hauler Name i <br /> IJ Q 0-uo <br /> Stampor sa K <br /> Hauler Telephone Number AddressssSame as Hauler InWaTs <br /> 1 j(N/A forI CERTIFY'TNT UNDER PENALTY OF PERJURY OF THE ` <br /> WROIe Thea) LAM OF THE STATE OF CALIFORNIA THAT THE <br /> _INFORMATION PROVIDED-E 9 TRUE AND CORRlCT.1 - <br /> am.. <br /> comprehensive • Log Number Load • •e 9 <br /> Site Suffix <br /> 3582822 -- B Pick Up Delivery93. <br /> a <br /> d <br /> Hauler Tire Program ID ! Slte Suffix Facility Telephone Number. <br /> DATE-®®-/—�®./ D® – . <br /> p []Weight asME <br /> �. <br /> 1 io w Whole Tire Count in Lbs. <br /> S F;�riIjhr gtic l,u C. �7a. <br /> cy -,... O •S .�- .� �' �-'O Volume Cubic Yds. Weight in Tons' d-VM:_aJ neC/^�ttr"atjYjRNIA;iNC:I - <br /> E _cJ1084.OrAUAMON7-PASS RD. ._ <br /> uler Name- - <br /> LD �t Tn LIVERMORE,CA 94550 9745. .J <br /> rT91L� /1/tE �2� o y_P nc <br /> U Hatiler.•;Tele hone Nurntier` = a a:a ■' cj_► Al r 5 0a s Hauler :_ �y,� <br /> T/M <br /> N 1 (- (r Jp / f (11,/p fpr ?'1 CERT FY T UNDER PENALTY OF?WURY OF <br /> TME 1NE I <br /> ,1�/O�. `1 0 5:.•nsa�'}.S :'.W11ole TIleB)-:^NWB OF THE STATEOFCALIFORNIA iNAT 1 VV MFORMAT ON PROVIDED ABOVE Is TRUE AND CORRECT. <br /> Comprehensive • e• Number LoadInformation9 Site Suffix <br /> 3582822 -"A X Pickup �'Deuvery © © IJ 0 0 U H—© <br /> Q) Hauler Tire Program ID ! Site Suffix! Facility Telephone Number <br /> . DATE ub/ I ly �(" oo®-®ao ©oo <br /> Cd UUhole Tire Count E]Welght In Lbs. <br /> s a.,IJtI WyEoify.I u4J;esS)o F'r c <br /> v a 5 2 2 — Volume Cublc Yds.❑Weight in TorisdreH uler ame e afid /�j IGrn J� <br /> Hauler Telephone Number a' ■ . Address Same as Hauler Inmd/,1 <br /> . for 'I CERTIFY TNAT UNDER PENALTY OF PENJURr OF THE <br /> 2 S Whole TI Ba LAWS OF TILE STATE OF CALIFORNIA THAT TME <br /> (N!A <br /> INFORMATION PROVIDED ABOVE IS ME AND CORRECT. <br />
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