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COMPLIANCE INFO_2018
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PINE
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845
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2200 - Hazardous Waste Program
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PR0507085
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COMPLIANCE INFO_2018
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Entry Properties
Last modified
9/24/2020 5:44:02 PM
Creation date
9/24/2020 2:50:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2018
RECORD_ID
PR0507085
PE
2227
FACILITY_ID
FA0004925
FACILITY_NAME
Caltrans-Lodi
STREET_NUMBER
845
Direction
E
STREET_NAME
PINE
STREET_TYPE
St
City
Lodi
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
845 E Pine St
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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PoDNETdsoitl TX 75080aMANAGER OOCP. ssEDmRnEDULeD scHERODUDFORSERVCECALI BRANCH <br /> roay. <br /> CU: )ER NO. <br /> .. ..-:.', cflEDrc. - <br /> F1CODE FREViOUS BALANCE BAL OVER 80 DAYS' <br /> 'CHAIN SVC,PTC PROD.P/F. <br /> .. ��;- ,• � . COCATLON F ' .TAX EXEMPTION NUMBER <br /> Y. <br /> SERVICE DATE ISALES REP NO.I <br /> -CUSTOMER P.O.NUMBER CUSTOMER PHONE 4 - - TAX COOS DATE EOPT/PROD ORDERED SERVICE TAX' C.O.M.S.TAX PRODUCT TAX <br /> , <br /> SERVICE! SURVEY SALES TOTAL CHLORINE TEST RESULTS SKDOT SERVICE CHANGE cxumE PROMO <br /> oEPi . UNIT PRICE QUANTITY CHARGE XAIOGEMiE4fcq CHLOR CC SERVICE IEPM 6CXXATE RELEASE NO. <br /> PRODUCT NUMBER TAX CHARGE NUMBER TERM. y I+ „I,;.: NO. <br /> AME SM Pp11LC OR TE(3T N114LL5. <br /> ..a.. ❑ <br /> j i7 El <br /> n ❑ <br /> a 'cl ❑ <br /> .❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> TANK ••• DATE <br /> TOTAL-SERVICE/PRODUCTS GAPACITv <br /> •• • • :m • MANIFEST NO USEPA TRANSPORTER ID NO. ` :^• -^� : ' x <br /> GENERATOR: •VEHICLE OTHER 1NOPREO11ALREOUIRED,N011ALOGENTEST -PRINT NAME ✓'.SIGNATURE n <br /> HAZARDOUS WASTE FLUIDS NON-VEHICLE > ,_.� . .v1�-s;Tt , .,� r�,A.x;1, gam:• ' DATE <br /> CLASSIFICATION* ONLY .' FLUIDS 2 NOPREOUEQUIRE ,NO HALOGEN TESTAT PIpC-UP - <br /> sPREDUN.REOUIRED,NO HALOGEN TEST - GENERATOR USEPA lO Nc},:.. GENERATOR STATE IONO. c <br /> CESQG ❑ 1 ❑3 4 PREDIIALRECUIRED,HALOGEN.TESTATPIMK X o <br /> SQG/LQG ❑.2 ❑4 °REFER TO REVERSE SIDE FOR DEFINITIONS PRINT NAME - <br /> SIGNATURE <br /> 11,US DOT DESCRIPTION(INCLUDING PROPER SHIPPING NAME,HAZARD£LASS,AND ID.) lZWNTAINESS 13.. %mv 1 UNrc sNoor NUMFFR <br /> wt <br /> r� { .J L,:f , ... S.i": _ _I.✓?, t 1« .y,�3vr N.a°oIn V,� <br /> >(; <br /> UJ C <br /> xLE <br /> s�: 1JT11 <br /> Xc <br /> Lu <br /> INTERMEDIATE FACILITY NAME AND ADDRESSUSA EPA 10 NO <br /> £ W <br /> . a.0 <br /> *3 B STATE ID NO: 1 <br /> u <br /> -CASH ❑ !.r TOTAL RECEIVED APPLYPAYMENTTO:- CHARGE.MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE TOTAL;DUE <br /> CHECK NUMBER ❑moms SERW0S$AUi INDICATED IN THE PAYMENT RECEIVED SECTION. <br /> C titerca0.s TWIM aCorcnumeC mat nok re pmpay clsssYby CemfieE.p kegettMee n P.".: Il h .A .. <br /> ❑MINIOUSSAIANCEASFOLLDWS nti labied,ax ere le Proper wndhan lot fm,et,ewba ammokm w thesppY ehttpeors ar 1. <br /> US.ISM..W Pmlxfttrey eM lheUS Uueehnml eeTm rledae. <br /> INVOICE# AMOUNTS INVOICE# AMOUNTS - ADDITIONAL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS <br /> PREVIOUS ,_,. ., „_ MAMFESTCDDE SEC# DOCUMENP aRE INCOPPORATED HEREWITH MADE A PART HEREOF. <br /> CREDIT Frii a Is ;P <br /> CAmmo Nam <br /> GREOiT CARD NO. --AMEX 1 EXP,.,DA7E <br /> , <br /> Y <br /> C116T0 VISA I �_,:a OF <br /> ! c� aEs rckTVESIGNERu <br /> --- 6ENERATORlSHIP DESIGNATED RFP GN T RE <br /> MER REFERENCE I ! i I 1 <br /> INFORMATION _- I. 1 -__ I__J i.. '1 14 '1 - c I a. <br />
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