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ARCHIVED REPORTS_REMEDIAL ACTION DOCUMENT
Environmental Health - Public
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EHD Program Facility Records by Street Name
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WILLOW GLEN
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13751
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2900 - Site Mitigation Program
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PR0009025
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ARCHIVED REPORTS_REMEDIAL ACTION DOCUMENT
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Last modified
5/19/2021 2:55:48 PM
Creation date
5/19/2021 12:15:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
REMEDIAL ACTION DOCUMENT
RECORD_ID
PR0009025
PE
2960
FACILITY_ID
FA0004055
FACILITY_NAME
LATHROP GAS DEHYDRATOR
STREET_NUMBER
13751
Direction
S
STREET_NAME
WILLOW GLEN
STREET_TYPE
RD
City
STOCKTON
Zip
95206
APN
19105010
CURRENT_STATUS
01
SITE_LOCATION
13751 S WILLOW GLEN RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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U Keller canyon U Ux mountain l-1 Newny Islana �tg_forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,GA 95035 Manteca,CA 95336 <br /> Phone;(925)458-9800 Phone(650)726-1819 Phone(408)-945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> [GENERATOR WASTE ACCEPTANCE NO. <br /> a, c Gas clk F Ie-ctri- <br /> MAILING ADDRESS <br /> . . e Shve,Mail Stop B24A 431-4 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S=Frmcisco,CA 94120 O GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> (d 3. 973.1773 O TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> Rost Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> �.(1na- <br /> GENERATOR'S CERTIFICATION:I hereby cert t the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 orlitle 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to apphcabie <br /> regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> .c. - subject to the Land Disposal Restrictions,f certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordancewith the requirements of 40 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. - <br /> WASTE TYPE: <br /> MSPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY' <br /> Ladimp I3ehycfrafs�r at:vn LATHROP <br /> '1 riANSPO..RTER NOTES: VEHICLE <br /> <br /> 320 Den&Stetc4hi <br /> A CITY, STATE,ZIP <br /> Wiaa C`A9549 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> l i74T S38-1407 ' ❑ ❑ <br /> SIGNATURE OF AUTHO E AGENT OR DRIVER DATE ROL -OFF(S) FLAT-BED VAN DRUMS <br /> r CUBIC YARDS <br /> A, <br /> hereby certify that the above named material has been <br /> s accepted and to the best of my knowledge the foregoing <br /> IS.true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> o U SOIL <br /> Y EMARKS <br /> s <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER U DEBNONRIS <br /> FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDUUNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED.WADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 2896314 <br /> QQ6314 <br />
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