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ARCHIVED REPORTS XR0012758
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CAPITOL
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6421
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2900 - Site Mitigation Program
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PR0522496
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ARCHIVED REPORTS XR0012758
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Entry Properties
Last modified
2/15/2019 4:45:15 PM
Creation date
2/15/2019 2:49:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012758
RECORD_ID
PR0522496
PE
2957
FACILITY_ID
FA0015317
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95245
APN
05532024
CURRENT_STATUS
02
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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i a I'llO{'! <br /> ,. Vh. <br /> Chain-of-Custody Icecordf <br /> Chevron Facility No. _ Chevron Contact(dame) _— <br /> Facility Address 61// r ✓.�i,,,i„ o' G�.f, -f�? (Phone) <br /> Chevron U.S.A.Inc. <br /> H.O.Boz 5004 — <br /> Consultant Project Number o) Laboratory Nome } <br /> San F amon,CA 94583 Consultant Name SIERRA ENVIRONMENTAL SERVICES Laboralo Rebase Number <br /> rY — <br /> FAX(415)642.4591 Add,,,, P-O. Box 2S46, Martinez, CA 94553 r - <br /> _ Samples Colloctod by(Name) <br /> Project Contact(Name) <br /> (Phone) (415j 370-1280 I Collection Raief� " a <br /> 370. <br /> (FAX Number) (415) 7959 Signature a _• ll ____�.— �fr-j��r--,j' <br /> j n ANALYSIS TO BE PERFORMED <br /> c a0 a <br /> � - <br /> = - G 3 <br /> 3 • <br /> - <br /> 3 c c <br /> _ .-... -- --' --'-- - -_r�._.__ ii �--- W._4 __.._---_._.. _.--------- •`fit ��'` <br /> t le .BY tZ'T <br /> tlprs) rpanlzadon Oa e!'Ime neceNsd By(S lure) - O[¢anl2all�- pT Io/T�me h.,n A.o.,na inn..ICnc4 Owe) w <br /> !G• A V 3 j1 i - 24 hour•-..IlnQulahad Byapr Orparkallaf ratan Or anuallon 4i hours Al <br /> ...._._. t tma.___.-- flecehoa.t7y_(a!p...__} . 9 [.•nRirrri-� - � �.. <br /> •I(hV y I t¢natur• <br /> H ulitgd0 S ) Orpanlxatlon47yn. Ratko t'Lei.wal S rs�tura -'� - I— - <br /> by t W ) Da.s(rlm•—� �"7a-dey <br /> �.� - <br /> /7 Centracl•Q <br /> 3! F <br /> �lw F <br /> c <br /> a k <br />
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