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ARCHIVED REPORTS_XR0002238
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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574
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3500 - Local Oversight Program
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PR0545205
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ARCHIVED REPORTS_XR0002238
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Entry Properties
Last modified
1/27/2020 3:47:34 PM
Creation date
1/27/2020 3:17:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002238
RECORD_ID
PR0545205
PE
3528
FACILITY_ID
FA0003164
FACILITY_NAME
NORTH POLE GAS & FOOD INC
STREET_NUMBER
574
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
574 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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1220 Quarry Lane • Pleasanton CA 94566-4756 Reference <br /> EL ' I STL San Francisco Phone (925) 484-1919 • Fax (925) 484-1096 <br /> Chain of Custody ;O�amt fo cf slab c Date L l a Page 1,of 1 _ <br /> . + <br /> bll Analysis _ _ <br /> st <br /> Attn l�"q a <br /> X CO CO <br /> Company o w I < U. <br /> w CO� ❑ <br /> o �L ❑m > 'y ❑❑ m a O OQ <br /> Address nYr 11t ❑❑ v in m o cv m ❑ $ Y a z a <br /> m ❑ [� an v 6 Dow ❑ E z ¢P ❑❑ <br /> Phone Zs'�l0" Email �X U, ❑� ❑o ar Um ul� aF caw o n J ❑❑ (5 w <br /> u,W mo o m �N 0 ❑❑ aQ n U Up V)Z <br /> Bill To Sampled By CO E°° "'o o m `3 U❑ w w m o ❑ o v ❑❑ m <br /> ❑ O❑ O oo m Cm 0 d N h U to air C <br /> ❑ m a ° a< mw mQ w ❑❑ ❑ C ro F yv U 5m` o <br /> w a mw pm m� �^ mQ a mN ❑❑ U <br /> Attn Phone ix w mw w In m�j m¢ o¢ �'D n 10 ❑ wU axiom nu�j <br /> [A n h Z a (0 N w <br /> TO Ow a0 a,,i j mw gw mQ Nm ¢ �a E <br /> SOM le ID - Q. <br /> a'm w❑ w❑ a'= �❑ m❑ OR iia a Uw SCJ 0 �❑ 0l a <br /> z <br /> c 1525 W <br /> I <br /> ProjectSampleReceipt1}Relinquished by 2)Relinquished by 3)Relinquished by <br /> Project Name #of Containers 315 <br /> Srn Ji UMOC Signature Time Signature Time Signature Time <br /> Proli t# Head Space <br /> 32 s Y r, k Addle 44 'Pl� 47 <br /> PO# Temp Panted Name Date Printed Name Date Panted Name Date <br /> Credit Card# Conforms to record Company Company Company <br /> ]J� td 5 72h 48h 24h Other 1}Received by 2)Received by Received by <br /> T Day <br /> Repo ❑Routine ❑Level 3 ❑Level 4 ❑EDD ❑State Tank Fund EDF Signature Time Signature Time Si nature / line <br /> Special instructions/Comments ❑Global ll) <br /> L t l <br /> Printed Name Date Printed Name Date Printed Name --I/ Date <br /> S-rL_ sF 31c z <br /> Company Company Company ` <br /> Re-at1o2 <br />
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