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ARCHIVED REPORTS_XR0002410
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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G
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GRANT LINE
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455
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3500 - Local Oversight Program
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PR0545202
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ARCHIVED REPORTS_XR0002410
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Entry Properties
Last modified
1/27/2020 11:06:10 AM
Creation date
1/27/2020 10:25:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002410
RECORD_ID
PR0545202
PE
3528
FACILITY_ID
FA0003124
FACILITY_NAME
7-ELEVEN INC. STORE #20304
STREET_NUMBER
455
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
455 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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fLj n Waste No 7 <br /> m" Systems <br /> B ING-FERRtS�tNDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> s <br /> Generator Name SOUITU,'M CORP- ATION Generating E_ocation <br /> Address-19033 H. VAU" MqY. D104- Address 55 MA= T.= EMn <br /> T rr, Ear 98432 rMOCY, � -. <br /> 2 0 z � 5 # 5 5 � � 7 b — 3 7 2_T_17 0 01 <br /> Phone No �^ - ` Phone No <br /> -y <br /> r r Containers -Type <br /> BF1 Waste Code t4 D-Drum <br /> Description of Waste <br /> Quantity Units No T e <br /> n C-Carton <br /> L 1 f)#7 T B-gag <br /> ,'--T=": aDt�,�AVMU= SOIL <br /> ff-Truck <br /> m ❑ P -Pounds <br /> Y-Yards <br /> EI 1:1 ❑ 1:1 0-Cther <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable ' <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly de_scnbed, <br /> classified and packaged, and is to proper condition for transportation,accordi to applicable regulations " <br /> for Authorized Agent Name Signature " Shipment Date <br /> Truck No Phone No <br /> �fJ i �-j 1rs �S r2 <br /> Transporter Name Driver Name (Print) <br /> r Y oS ✓c» Vehicle Ucense No !State <br /> Address - <br /> J <br /> Cyd Vehicle Certification <br /> I hereby certify that the above named matenal was picked up l hereby certify that the ab9ve named material was-dellv6ed with=_ <br /> at the generator site listed above out incident ttto/�the dest�n list .d below <br /> ,aver Sagrwure Stupment Date Drs76t signature 'Dalnrety D e <br /> ` - I <br /> DESTINATION <br /> Site dame Phone No <br /> Address <br /> 1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> 72 <br /> Name of Authorized Dent Seanewre ReewD1 Dere <br /> PASS CODE <br /> f - t <br /> ��,���� i �- BR260-72: <br />
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