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COJFFCKNO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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DODDS
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21657
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2500 – Emergency Response Program
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COJFFCKNO
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Last modified
7/11/2023 2:43:36 PM
Creation date
7/11/2023 1:35:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COJFFCKNO
PE
2546
STREET_NUMBER
21657
Direction
E
STREET_NAME
DODDS
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
20520005
ENTERED_DATE
4/13/2021 12:00:00 AM
SITE_LOCATION
21657 E DODDS RD
RECEIVED_DATE
4/13/2021 12:00:00 AM
P_LOCATION
06
P_DISTRICT
004
QC Status
Approved
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SJGOV\bmascaro
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EHD - Public
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SCALE IN (;Rnss WEIGHT 48,020 NET TONS 4.14 <br />SCALE OUT TARE WEIGHT 39,740 NET WEIGHT 8,280 <br />INBOUND <br />INVOICE <br />dM CONTAIIER VEHICLE • <br />1 5. c2.7.31 <br />CELL <br />YU <br />WEWMMAWMR <br />DATE/TIME IN ChList,na <br />REFERENCE <br />(SITE TICKET <br />DATE/TIME OUT <br />SITE <br />FORWARD LANDFILL -- <br />9999 S AUSTIN RD MANTECA, CA 95336 <br />CUSTOMER <br />009166 <br />USC <br />ACCOUNTS PAYABLE <br />STOCKTON, CA 95203 <br />Contract: 4204Y911178 <br />Generator: PG&E <br />BILL OF LADING <br />5534422 <br />OTY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL Ns, <br />10.00 <br />4.19 <br />YD <br />tn <br />Tracking QTY <br />SW-CONT SOIL Origin : ESCALON 100% <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 />NET AMOUNT <br />TENDERED <br />CHANGE <br />CHECK# <br />SITE <br />FORWARD LANDFILL -- <br />9999 S AUSTIN RD -MANTECA, CA 95336 <br />"SITE TICKET <br />Y8 1552731 CELL <br />WEIGHMASTER <br />Christina G. <br />CUSTOMER 009166 <br />P S C <br />ACCOUNTS PAYABLE <br />STOCKTON, CA 95203 <br />Contract: 4204Y911178 <br />Generator: PG&E <br />DATE/TIME IN <br />4/22/21 8:30 am <br />DATE/TIME OUT <br />4/22/21 8:55 am <br />VEHICLE <br />PSC 181132 <br />CONTAINER <br />REFERENCE <br />BILL OF LADING 553/122 <br />SCALE IN GROSS WEIGHT <br />SCALE OUT TARE WEIGHT <br />48,020 <br />39,740 <br />NET TONS <br />NET WEIGHT <br />1.14 <br />8,280 <br />INBOUND <br />INVOICE <br />OTY. UNIT DESCRIPTION RATE EXTENSION , TAX <br />.... <br />TOTAL <br />10.00 <br />1.14 <br />YD <br />tn <br />Tracking QTY <br />SW-CONT SOIL Origin: ESCALON 100% <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 />NET AMOUNT <br />TENDERED <br />CHANGE <br />CHECKS <br />, SIGNATURE R - 42UPR (04/1 9)
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