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CO004CN0S (2)
EnvironmentalHealth
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2500 – Emergency Response Program
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CO004CN0S (2)
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Entry Properties
Last modified
8/25/2021 2:49:02 PM
Creation date
8/25/2021 2:41:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO004CN0S
PE
2546
STREET_NUMBER
12700
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19603008
ENTERED_DATE
4/15/2021 12:00:00 AM
SITE_LOCATION
12700 S HARLAN RD
RECEIVED_DATE
4/15/2021 12:00:00 AM
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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ZIP STATE <br />UNIT <br />WTNOL TOTAL <br />QUANTITY <br />DOCUMENT N <br />I <br /> <br /> <br />e <br />TRANsPOPITE <br />__ R 1 . <br />TRANSPORTER 2 ._ _ <br />EPA ,'D # <br />11 4 STRAIGHT BILL OF LADING VEHICLE ID # <br />TRANS. 1 PHONE <br />_— VEHICLE ID # <br />TRANS. 2 PHONE <br />- - <br />- - • <br />STATE <br />DESCRIPTION OF MATERIALS <br />ZIP <br />SHIPPER <br />SHIFPEVEPA ID # <br />ADbRESS <br />CITy ADI5RESS <br />tCONTAINERS[ <br />—H- <br />D. <br /> <br /> <br />1 <br />SPECIAL HANDLING INSTRUCTIONS <br />-DESIGNATED FACILITY— <br />FACILiTY-E-PA <br />PRINT <br />TRANSPORTER 1 PRINT - - <br />TRANSPORTER 2 <br />-PRINT <br />RECEIVED BY <br />PRINT <br />SHIPPER <br />WORK ORDEV-1 NO. _ <br />SHIPPERS CERTIFICATION: This is to certify that the above named materials are properly classified, <br />described, packaged, marked and labeled and are in proper condition for transportation according to <br />the applicable regulations of the Department of Transportation. <br />SIGN <br />SIGN <br />SIGN <br />SIGN <br />DATE <br />DATE - <br />DATE <br />DAT E
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