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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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2200 - Hazardous Waste Program
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PR0518181
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
10/1/2020 3:34:55 PM
Creation date
10/1/2020 3:10:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0518181
PE
2220
FACILITY_ID
FA0003610
FACILITY_NAME
A&A GAS & FOOD MART
STREET_NUMBER
16
Direction
E
STREET_NAME
HARDING
STREET_TYPE
WAY
City
STOCKTON
Zip
95204
APN
13902001
CURRENT_STATUS
01
SITE_LOCATION
16 E HARDING WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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State of Californio—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039 IF.-;...•n'^^" <br /> a=-•-` ces <br /> Ple <br /> See Instructions on L of page 6. 1Tax <br /> State of California—Environmental protection Agency <br /> s 9 ncy Co• <br /> Approved OMB Na.2050-0039(Expire, itch ewriter. 2. Pae 1 Infcimento;es <br /> Fon, h,P Form designed For use on elite F 12"P I typ Manifest Document No. 9 o <br /> Fo "e pant or a is n d� <br /> 1. Generator's US EPA ID No- ^ E v Federo <br /> UNIFORM <br /> WASTE MANIFEST <br /> O� � �5 -7 U of <br /> A. State Manifest Document Number� <br /> 0- <br /> 3. <br /> � <br /> 3. Generator's Name and Moiling Address t Coast Products I�G �L7 L� <br /> `n BP Wes B. Slate Generators ID �— <br /> P.O.Bose 90877 H IV IF IF 13 $ 1 0 2 <br /> CA 90009 <br /> 7£f7-4600 Los Angeles, <br /> °D C. ID Number C State Transporter's ID[Reserve 1 <br /> 0 4. Generator's Phone[31 1 6. US EPA - <br /> a�p N 5. Transporter 1 Company Name D Transporter SPf one <br /> (949)450 1010 <br /> co SerOiCeS,Inc E $rale Transporter's ID(Reserved 1 <br /> Q oo Belshire Envuorunenti;l r <br /> 8. US EPA ID Number <br /> Name <br /> U ao 7. Transporter 2 Company F Transporters Phone t r <br /> Q <br /> G $tate Facility's ID <br /> mber <br /> Z <br /> J 1 1 <br /> V 9. Designated Facility Name and Site Address H; Facility's Phone <br /> J Q Delvlenno Taprdoon (3 10)537-7 100 <br /> % z 2000 North Alameda Sweet 'p 1 5 13. Tatar 14. Unit <br /> O Compton,CA 90222 12. Containers Wt/Vol 1. Waste Nui <br /> Z o No. Type Quantity _. <br /> a- Hazard Class,and ID Number) State - <br /> = J ]34 <br /> US DOT Description(including Proper Shipping Name, <br /> 3 G the <br /> V EPA/Or <br /> E Z Ga-oline hti�e D j CT Exe <br /> o N = 3 T241 203 P.G.11 $tate <br /> oD <br /> E 3 G (Not Re aRCRAWaste) <br /> EPA/Other <br /> v o <br /> A Nb <br /> O State <br /> T b E <br /> ao O v R <br /> R •4 EPA/Other <br /> A c. <br /> Lu <br /> T stare <br /> Z ` — R EPA/Other <br /> U .- <br /> Y <br /> W L <br /> un Desci <br /> Z L K. Handling Codes For Wastes Listed Above <br /> O 6- <br /> a_ <br /> Lu n J. Additional Descriphonsfar Materials ListedbCY g, PONSE CT. <br /> E N0. 128 �a,=; ; <br /> 2000 North�snencan EMF:R ed as of 7anuuy,1996 d <br /> 0 1e LDR Notification statement is riot requir <br /> HSC Citation 2517 9.6 BESI# 61914 <br /> Q ARCO 4932 <br /> Z 15, Special Handing Instructions and Additional Information clothing <br /> _ Gasoline and Water mixture. Wear apPrOPnste Protective r++•'tr 16 East Harding Way <br /> i <br /> Emergency Phone) Stodaon,CA <br /> Zj 16 (949)7 5 3-5 826(24 ho>4 <br /> on-Fri 7 a'i1 to Spin) y Y ro per ship mg name and are classifiec <br /> J u (949)450-1010(M .g yj' <br /> b highway according to Opp <br /> ad <br /> international and naris na government regulations. <br /> � CERTIFICATION: I hereby declare that the contents of this conn nment are full and accurotel described above p P <br /> 16. GENERATOR'S 13 <br /> rz L marked,and labeled,and are in all respects in proper condition for transport y <br /> N <br /> � or disposal currently available to me which minimizes the present and future threat k <br /> ntit <br /> generator,I certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I have determine to <br /> O If I am a large qua y 9 � F ood faith effort to minimize my waste generation and select the best waste management <br /> Prin practicable and that I haveif I amen smallrqutan�tyegenehotoro It have m�de�org e, P Month <br /> d the <br /> V � nd the environment;OR, <br /> Z available to me and that I can afford. Signature v <br /> w <br /> � R 17. Printed/Typed Nome of ARCO <br /> LL, N Print ; LXry Moed r 1P+P a5 agent Month <br /> wS Signature j Q <br /> P J T 17. Trans arter 1 Acknowled ement of Recei t of 1Ols <br /> 0 18. R Printed/Typed No �G l`�,G�j`"'/ <br /> O T Month <br /> Printe J N <br /> W E <br /> N R J Signature <br /> Q 18. Trans orter 2 Acknowled emenl of Recei t of Materials <br /> V 19. C <br /> F )- T Printed/Typed Nome <br /> Z A t E <br /> t j 19. Discrepancylndicotion Space <br /> _ F <br /> 20. Fa A <br /> T' Printed C t m 9- <br /> I <br /> r Month <br /> Y t <br /> f cU. Facili Owner or O erotor Certification of Teter t of hazardous materials gnatuee b this manifest exce s no iffi <br /> T Tinted/Typed Name /n <br /> Y C l LINE. <br /> DTSC <br /> DO NOT WRI BELOW <br /> DTSC 8022A (1/5 TSDF SENDS THIS COPY TO DTSC V <br /> EPA 8700-22 White S <br /> To. P.O Box 3000, Sacramento, CA <br />
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