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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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2200 - Hazardous Waste Program
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PR0516229
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COMPLIANCE INFO_PRE 2019
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Last modified
12/7/2021 12:56:39 PM
Creation date
10/8/2020 2:03:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0516229
PE
2227
FACILITY_ID
FA0012386
FACILITY_NAME
BRANNON TIRE - CLAREMONT
STREET_NUMBER
4905
STREET_NAME
CLAREMONT
City
STOCKTON
Zip
95207
APN
10223010
CURRENT_STATUS
02
SITE_LOCATION
4905 CLAREMONT
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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1187 VANDERBILT CIA. #2 <br /> �'. CALIFORNIA COOLANT SERVICE MANTECA, CA 95337 <br /> -Your California Antifreeze Service Com any OFFICE: 209-239-5587 <br /> Transporter EPA#CAR000047167 <br /> p FAX: 209-239-6316 <br /> SERVICE ORDER: 55400 <br /> Customer <br /> MANIFEST# 8 <br /> Brannon Tin (SRYKHE9912$8540000Jj 7 //__ -7 <br /> 1905 Claremont Ave. /Marsh'Lane �� 0a S ? 7 cl��/ Y <br /> ocMon, CA 95207 1 <br /> 209.477-9000 <br /> ..PA#CAL 000 198 530 Customer# 1280 Contact:Charles Baler Terms; Net 30 SM. Loins Machado <br /> CODE DESCRIPTION CITY UNIT PRICE AMOUNT <br /> 50 Prestone-Prima 50150 AIF 5 -,eL i) T <br /> Waste ArriHreei Pldc Up f V /'U c C <br /> Tank Serial Numbers: Non Taxable Sub Total <br /> Taxable Sub Total 7� <br /> Tax <br /> TOTAL DUEL/ <br /> WASTE DISPOSAL INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LI UID(USED OIL/MIXED OIL)'NO PLACARDS REQUIRED- STATE CODE 221 <br /> K NON-RCRA HAZARDOUS WASTE,LI UID(ETHYLENE GLYCOL SOLUTIONS)-NO PLACARDS REQUIRED' STATE CODE 134 <br /> ❑ OTHER: <br /> ❑ DESIGNATEDTSDF: <br /> ❑ EVERGREEN OIL,INC.: 6880 Smith Avenue•Newark,CA -CAD980887418-(510)795-4400 <br /> ❑ THERMO FLUIDS: 655 South Stanford Way•Sparks,NV 89431 -NVD982510711 -(775)219-7396 <br /> ❑ D/K DIXON: 7300 Chevron Way Dixon,CA 95620-CAT080012602•(707)693-6008 <br /> ❑,f�RAMOS ENVIRONMENTAL: 151 S.River Road-W.Sacramento,CA 95691 -CAD044003556-(916)371-5747 <br /> IrNU-SET INDUSTRIES: 977 South 700 West-Salt Lake City,UT 84104-UTD982589459-(801)977-0220 <br /> ❑ ALTERNATE TSDF: l _ <br /> D CFR: 33210 Western Avenue-Union City,CA 94587-(510)487-9277 <br /> (All Generators/Customers MUST read the following text.) <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimize the present <br /> and future threat to human life and the environment; Or,if I am a small quantity generator,I have made a good faith to minimize my waste generation and select the <br /> best waste management method that is available to me that I can afford. <br /> '1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES <br /> NOT CONTAIN ANY P.C.B'S. <br /> '1 FURTHER AGREE TO AC THE ADDITI NAL CHARGES FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. <br /> i, <br /> Customer S(griat re Date D �r�Sign�ature Date <br /> Print Name Print Driver's Name <br /> AIIreturned checks are subject to a$15.00 Service Charge. <br /> Allamounts not paid within 30 days of invoice are subject to 1 1/2%interest per month,18%annually on unpaid balance. <br />
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