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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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tF;+ k PF <br /> Chalin-of-Custody + '¢ <br /> y ��e�o�� F <br /> Chevron Facility No — ! '� '— <br /> Chevron Contact(Namo) <br /> FacitityAddros � hGhevrarU.S.A.Inc. <br /> (Phone) ..�1_ __ __ _ ;��• ���'��� <br /> P.O.Box 50oa Consultant Projecl Nu.abor ". J Laborarory Name <br /> SanRamon,GA 94583 Consultant Name SIERRA ENVIRONMENTAL SERVICES <br /> - * <br /> Laboratory Aalaase Number <br /> FAX(415)842-9591 Address P.O. BOX 2545 Martinez CA 94553 -- — -'. <br /> Project Coalacl{Hama) _ <br /> I ' Samples Collected by(Name) <br /> �` — �_- � c• ' i _-_ i i. I-rte_ <br /> (Phone) (415) 370.1280 _ <br /> Collection Date <br /> (FAX Number) (415) 370-7959 Signiluro <br /> 1 m ANALYSIS TO BE PERFORMED - -- <br /> 0 0 _ <br /> � I � I � - � � I <br /> 0 4U C7Uo c c <br /> ' t <br /> _ <br /> _ J <br /> 11. � <br /> v <br /> •- I <br /> k + <br /> k I i I <br /> EI L� d <br /> 11.a <br /> !s._ 11 <br /> 9 1 ganlzallon Dat-Ylma Flacelved By ll <br /> By(S�na!�reJ 1;-L n_ _ at r,,.n�,.-�ne T.—fC+c o.el gz <br /> 24 hours .:t� tEk.� ' <br /> alitr4ulahed BY(S!ii lura} Or nliallon a, lma Recerie6 0 S palma, <br /> Y l 17--1.._—�— -- Qr9anuaSbn Oolartlma �6 hours <br /> f10WIalaMd BY(Slpnalura) Orprnlzsllon c da a' --� <br /> - ---'-- Da1e/Tlma_, RacaN-d iarCatwufory y(Slgnalure) _ Dalefrlma to day. <br /> /Y" /� Ao Conlractad d <br /> d <br />
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