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COVEGSHNN (2)
Environmental Health - Public
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2500 – Emergency Response Program
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COVEGSHNN (2)
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Last modified
3/23/2022 4:03:04 PM
Creation date
3/23/2022 3:55:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COVEGSHNN
PE
2546
STREET_NUMBER
3031
STREET_NAME
NAVY
STREET_TYPE
DR
City
STOCKTON
Zip
95206
APN
14502007
ENTERED_DATE
1/12/2021 12:00:00 AM
SITE_LOCATION
3031 NAVY DR
RECEIVED_DATE
1/12/2021 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\ymoreno
Tags
EHD - Public
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Site I TICKET # <br />YS I 1540425 <br />CELL <br />WEIGHMASTER <br />'ThristinaS. DATE/TIME IN <br />3 /5 /21 10:12 am <br />DATE/TIME OUT <br />3/5/21 10:3:7 VEHICLE <br />ENVIRONMENTAL 6770 <br />CONTAINER am <br />REFERENCE <br />BILL OF LADING <br />1101709 <br />FORWARD LANDFILL -- <br />9999 S AUSTIN RD MANTECA, CA 95336 <br />:USTOMER <br />009993 <br />ENVIRONMENTAL LOGISTICS, INC. <br />MARIA GONZALEZ <br />COLTON, CA 92324. <br />Contract :42042123169 <br />Generator:YARA NORTH AMERICA <br /> <br />SCALE IN GROSS WEIGHT <br />54,320 NET TONS 12.63 <br />INBOUND <br /> <br />SCALE OUT TARE WEIGHT <br />29,060 NET WEIGHT <br />25,260 <br />INVOICE <br />OTY. UNIT oesawnom RATE EXTENSION TAX TOTAL <br />20.00 YD Tracking QTY <br />12.63 tn SW-BENEFICIAL REUSE Origin:STOCKTON 100% <br />1.00 ENVIRONMENTAL FEE 1 <br />1.00 FUEL RECOVERY FEE <br />The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions <br />on the reverse side and that he or she has the authority to sign this document on behalf of the customer. <br />RS-F042UPR (04/19) <br />SIGNATURE <br />NET AMOUNT <br />TENDERED <br />CHANGE <br />CHECKS <br />'SITE y8 TICKET # 1540425 10ELL <br />WE1GHMASTER Christina G. <br />DATE/TIME IN 3/5/21 10:12 am DATE/Tr),1 T1 ? am 10:37 <br />-C VEHICLE ENVIRONMENTAL 677 ONTAINERf <br />REFERENCE <br />BILL OF LADING 1101709 <br />ITE FORWARD LANDFILL -- <br />9999 S AUSTIN RD -MANTECA, CA 95336 <br />USTOMER 009993 <br />ENVIRONMENTAL LOGISTICS, INC. <br />MARIA GONZALEZ <br />COLTON, CA 92324 <br />Contract :42042123169 <br />Generator:YARA NORTH AMERICA <br /> <br />SCALE IN GROSS WEIGHT 54,320 <br /> NET TONS 12.63 <br /> INBOUND <br /> <br />SCALE OUT TARE WEIGHT 29,060 NET WEIGHT 25,260 INVOICE <br />QTY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br />20.00 YD Tracking QTY <br />12.63 to SW-BENEFICIAL REUSE Origin:STOCKTON 100% <br />1.00 ENVIRONMENTAL FEE 1 <br />1.00 FUEL RECOVERY FEE <br />NET AMOUNT <br />TENDERED <br />CHANGE The undersigned individual signing this document on behalf of Customer acknowledges that he or she has read and understands the terms and conditions <br />on the reverse side and that he or she has the authority to sign this document on behalf of the customer. <br />CHECKS <br />RS-F04211PR (04/1n) RWINATHPIP
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