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COEBXNBJK
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2500 – Emergency Response Program
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Last modified
3/7/2023 4:36:31 PM
Creation date
3/7/2023 4:35:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COEBXNBJK
PE
2546
FACILITY_NAME
ESCALON PRESBYTERIAN CHURCH
STREET_NUMBER
1612
STREET_NAME
FIRST
STREET_TYPE
ST
City
ESCALON
Zip
95230
APN
22711007
ENTERED_DATE
10/3/2022 12:00:00 AM
SITE_LOCATION
1612 FIRST ST, ESCALON, CA
RECEIVED_DATE
10/3/2022 12:00:00 AM
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Photos received from Celia via email on 1/30/2023 Rule, <br />Oak' 40 01 REPUBLIC <br />tipiA SE til t. I S <br />NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br />1861741 NBT <br />GENERATOR iGe,ti r <br />r <br />Phon, ' • • • <br />li Cv.r,v1 of the ere,e,,,t,,,j fa, ;lay nines tr,,n11,,i; 40,,e"AlD' ;- <br />: On"Wis 1r.e N, <br />t ri/ II! a '' Eth Catn 1 IaratN, Stirdpirli N3M+y and th Cot t net . n Total r <br />..I OuSCI.V11,y1 Na T Ouantity _ —t <br />•••1 NE.F.fr,10N S CEF T ICATa-A I hereby certify trial aye above named material ts not a haNydatts waste as defined by 40 CFR 261 Or any appf.icable <br />proonny din.oribed. cfassified and packaged and Is rn prayer condrbon lor transportation aixlaroing to applicable regufatAa15. AND. rf thn: I <br />....i.--mrdance wen the ruqurrerher Is of 40 CFR 2f8 and o no longer a ha:tardotrt waste as defined by 40 CFR 261 <br />retAdue 01 a previously resIncled hazardous waste sotarlot to the Land Drispcsas Restnctions I certify and warrant that the waste has <br />• I - •-• <br />- • • h r • <br />1 ,unzeo An. 7Pn1111 Signr-rture r Date <br />TRANSPORTER t Generator completes ha-b and Transporter completes Ilc.e) <br />3 z 1 <br />•rti: r -3 0 ,' t. h. t? <br />S-inature je Date <br />DESTINATION (Generator Complete Illa-c and Destination Site completes Illd-g) <br />D‘sposaI Fti ay and Sdir Addles& a US EPA Nurriber +:1 DisVePencY In,PrAtOn Space. <br />r. g'dit 119105 , <br />r ., • •••• r - r ..' te <br />i_herehy certify that the above named matertal titsa been accepted and to the torat of my know the for true ItOCUr11 <br />_e Name A.rrinnzed Alien! Thrill II Sronaturo Data <br />IV. ASBESTOS (Generator completes IVa-f and Operator complete IVg-s) <br />A operAtnes Name and Ar/dreaS C Re,sponsiblo Agerney Name eqc Addrest. <br />d Phone <br />e Special Handing Instructions and Additional Information <br />D Enable Non-Friabie-70 Both Friable Non.Friabie <br />OPERATORS CERTIFICATION i hereby declare Mat the contents 0 trot consignment are hilly and Bccaralety C.Ie5cribM1 C4Xivit: by the proper thwaig ram <br />1,^11 ll ClasSified. packaged. maned and tabeiectlarded, and are an at riaSPICIS In proper condition for transport atc.ortItng to applicable international and <br />mitonaLgovemmentai morrows <br />e Name arv Tteo Pint) <br />'Operator emirs al the compariY ',Ana Wasps,- renovation speration re both <br />e <br />_
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