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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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f <br /> Chai n-of-Custody Record ; <br /> �:i" <br /> =aUr <br /> Chevron Facility No. -'n'� Ctievron Contact(Name) // p <br /> Facility AddressCcs! 7JC�40GcJ ��CP tG�• /_� (Phone) y1 <br /> . ;.t <br /> Chevron U.S.A.Inc. _ a <br /> Consultant Projoct Numbcr Z 55-Qd Laboratory Nome <br /> P.O.Box 5004 <br /> Sart Ramon,CA 94583 Consultant Name SIERRA ENVIRONMENTAL SERVICES Laboratory Release Number <br /> P.O. Box 2596Martinez, C 9553 j ' <br /> FAX 415 842.9591 Address _ r <br /> } r 5ampl©s Collected by;llama) <br /> Project Contact(Name) l P✓5 i <br /> (Phone) (415) 370-121510 Collection Data <br /> l — — -- ---- ;' <br /> (FAX Numbe[) �415) 3707959 S�r�nalure _����L_-j�/�t-f�(���._ <br /> ! ANALYSIS 70 BE PERFORMED • <br /> g <br /> I Ln' <br /> 2 <br /> M. <br /> 41 1— <br /> n <br /> Rall utit*d rs1 nature Or nl;allan Dalw71ms Rau B nature or antiatlon Dalerrlme. !. r,m AF nd nm.(CrW one) <br /> Y fl ) tN Y(rgb 1 9 r (G <br /> 5r0 /./lG �dc./74cG.nn 5AC._ ✓^7 171 24 24houry _ r <br /> RNlraiulsirG y(518n urs) Oruar�lxallon mot jTs+ne ReceN+d©t{Sgrulure) Orpantxaiton Du•Rtme 44 hWra <br /> RaEYITpuL1hW 8y(Sto"wie) Orpa b Datarl tna ReeeNed for Labor■ t-pbnature) �Data/Tlma 10"yo s <br /> An Contracted ) 71 <br /> J� <br /> gggg <br /> Jiggly <br /> d= <br /> t <br /> r � at <br />
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