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2375
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2900 - Site Mitigation Program
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PR0519125
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COMPLIANCE INFO
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Entry Properties
Last modified
2/19/2020 11:39:12 AM
Creation date
2/19/2020 9:25:02 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0519125
PE
2950
FACILITY_ID
FA0014294
FACILITY_NAME
GRANT LINE SHELL
STREET_NUMBER
2375
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
21402017
CURRENT_STATUS
01
SITE_LOCATION
2375 GRANT LINE RD
P_LOCATION
03
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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c44 / OZJ 1 V ; J 1 r <br /> SreN JOAQUIN LOCAL HEALTH DISTRICT SERVIN , <br /> Jamas Culbertson, Pros. City of Lot <br /> Mary Anna Love. vice Pres , 1501 East Hazelton Avenue, P.O. Box 2009 San doaquln Count <br /> Pairwa IL vonnuccl. Seo'y. Ban Joaquin Coun , <br /> Tommy Joyce Stockton , Calitomia 95201 City a Escalo <br /> Earl PlmenlM <br /> City of Mantec <br /> Virginia Mathews po <br /> (209) 488 . 5781 City of Ripo <br /> Daniel L Flores City of Stocklo <br /> John 0. Most, M.D. Jogl Khanna, M.D.. M.P. H., District Heatth officer r tc , City of Trac <br /> (lane S. Kraham <br /> San Joaquin Count <br /> AUTI10RIZATION TO RELEASE ANALYTICAL RESULTS , GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> I , the undersigned owner and / or operator of the property and / or facility <br /> located at AP l f "til - 510 - 191 ; 1r? &r6eeh'6Wy1 of y1 20 .5 and t6 rant 1_ine ,d ; Train , CSI <br /> hereby authorize <br /> to release any and all analytical results , geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> as it is available and at the same time it is provided to me or my <br /> representative . <br /> Owner / Operator ; J 1� lx� Title : <br /> UL <br /> //►► ! <br /> Address �7v'/, �1y� � w-� y Phone : SIG G31 24 VT <br /> Date : <br /> EH 23 041 3 / 86 <br /> Ell <br />
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