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ARCHIVED REPORTS XR0000689
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 XR0000689
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Entry Properties
Last modified
2/15/2019 9:44:24 PM
Creation date
2/15/2019 4:07:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000689
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
Scanner
WNg
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EHD - Public
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fbgndeaignad °rxmebnepts 1 ia <br /> 4 r+Y tr <br /> NON-HAZARDOUS 1 Generators US EPA fD No Manifest Doc No 2TPagel <br /> WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address ' <br /> cheveron K, <br /> hwy 12 <br /> 4 Generalods(Rda.E(ca )209 467-1006 att tim <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transposer s Phone <br /> 3nviro tec n/a 434-0211 <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporter s Phone <br /> 9 Destgnated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> invlro tec n/a 434-0211 <br /> 2480 athens ave <br /> 1incoln , ca <br /> - 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit <br /> No Type Quantity wvvol a' <br /> a <br /> non haz 11au]-d nos 001 tt 2800 g <br /> x E <br /> fi N <br /> E z <br /> R <br /> A c >, <br /> O F <br /> R - <br /> d <br /> r I r <br /> w <br /> F� - <br /> L D Additional DesCnp,ions'o t}4a Er als Listed Above E Handli ig codes for t%.;stes Listed Abo e <br /> prune ;nater from tank <br /> r` I <br /> 15 Special hanoiing Ins,n,CI ons and Ado poral Wornai on <br /> ems r <br /> abco ' <br /> troy w 826-3803 <br /> 16 GE14ERATOR S CERTIFICATION i ce v tie a enal=_eese iced abo,e on, -narilesl a e not�,-_jcct to FdCrd cgJla'ons f0 ie;or- 1open C�PC'al ci Pazcrdoi,s VI.S.e i - <br /> PrinledrTv.ieo N=e Signalure fIcn h Day i ear <br /> r, <br /> T 17 Transpoi e 1 Ac,not lenge^cr+ct Poceip'of Nr,Er cls <br /> NPnniedrT ;nc Na—e Signa r onm Dsy )ear <br /> P BOB F E T TY �'>=/�'t/.4 15 1 19 <br /> O 18 Tra-tspor e 2 Acl ncv ieegernent of 9eceipt c'Va,enais <br /> R } <br /> 7 Pr,n ec,'T}ped Name � Signature - <br /> Von h Day ear <br /> E <br /> R <br /> 19 Discrepancy Inoicahon Space <br /> F <br /> A <br /> C <br /> L 20 "Ov�neTDrri'icahon of receip+o'wase materials Cove ed by'his manifest except as noted in bens 19 <br /> Signal nron,n i Day Year <br /> 5- 19 <br /> Printed by J J KELLER 8 ASSOCIATES ING 12-BLS-05 Rev 2/98 <br /> Neenah WI 54957 DM8 <br /> ORIGINAL- RETURN TO GENERATOR <br />
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