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ARCHIVED REPORTS_XR0010130
Environmental Health - Public
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EHD Program Facility Records by Street Name
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S
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SHAW
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1500
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3500 - Local Oversight Program
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PR0545688
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ARCHIVED REPORTS_XR0010130
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Last modified
5/21/2020 3:26:24 PM
Creation date
5/21/2020 10:05:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0010130
RECORD_ID
PR0545688
PE
3528
FACILITY_ID
FA0003634
FACILITY_NAME
CANTEEN CORPORATION
STREET_NUMBER
1500
Direction
N
STREET_NAME
SHAW
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
14326008
CURRENT_STATUS
02
SITE_LOCATION
1500 N SHAW RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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LSauers
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EHD - Public
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Wf <br /> GENERATOR WASTE PROFILE SHEET Page 1 oft <br /> ALLIED WASTE <br /> Waste Profile# <br /> Requested Disposal Facility 6R,y Ap-t) tL�(" <br /> an Allied Waste Company AW I Sales Rep <br /> 1. Generator Information Date <br /> Generator Name U S. <br /> Generator Site Address ,$`Q _ <, + <br /> City County � State CA Zip S <br /> State ID/Reg No State Approval)Vlla Code (Ef applicable) SIC Code <br /> Generator Mailing Address (if different) �z ' <br /> - City �- Cto <br /> ty State Zip <br /> Generator Contact Name -E- I ? <br /> Phone Number Z'� *--� F Number 7 r w� <br /> Ila. Transporter Information <br /> Transporter Name (t} L9C. �µ3G— Contact Name <br /> Transporter Address p.o+ 1400 <br /> city �p County State �A zip Sz 3 <br /> Phone Number 7ZT•fS?71 Fax Number State Transportation Number <br /> 111b. Billing Information _ <br /> AWK <br /> Bill To L 73 � U1KJAZr Contact Name Iq <br /> Billing Address t?do G dA p State�LJ.m-*- <br /> City 15 lowF.D Zi 505'77 Phone Number 5ZT-Wd <br /> III. Waste Stream Information <br /> Name of Waste r-n' f <br /> Process Generating Waste r <br /> Type of Waste ❑ INDUSTRIAL PROCESS WASTE or OLLUTION CONTROL WASTE <br /> Physical State a-SOLID ❑ SEMI-SOLID ❑ POWDER ❑ LIQUID ❑ OTHER <br /> Method of Shipment E-tULK ❑ DRUM ❑ BAGGED ❑ OTHER <br /> Estimated Annual Volume ❑ CUBIC YARDS ['TONS ❑ GALLONS ❑ OTHER <br /> Frequency NE TIME ❑ DAILY ❑WEEKLY ❑ MONTHLY ❑ OTHER <br /> Special Handling instructions ' <br /> IV. Representative Sample Certification ❑ NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory <br /> analysis, collected in accordance with U S EPA 40 CFR 261 20(c) guidelines or [FOES or ❑ NO <br /> equivalent rules <br /> Sample Date "' Type of Sa ple ❑ COMPOSITE SAMPLE YGRAB SAMPLE <br /> Laboratory S`t. S mple ID Numbers S! l ST L 5 <br /> Sampler's Employer g � i� f <br /> Sampler's Name (panted) Signature <br /> ©Allied Waste,February 2001 <br /> REV 1 <br />
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