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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
Tags
EHD - Public
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N <br /> pp i <br /> -,(Porro des+�Bd�ane a2pltd� ewdter � <br /> Ot <br /> NON-HAZARDOUS 1 Generators US EPA ID No Mandesl Doc No 2 Pagel <br /> WASTE MANIFEST n/a 0001 1 o 1 <br /> 3 Generalor s Name and Mailing Address <br /> cheveron <br /> hwy 12 <br /> 4 Generators P}tdad1 , Ca) 209 467-1006 att, tim <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporters Phone <br /> snviro tec n/a 434-0211 ' <br /> 7 Transposer 2 Company Name 8 US EPA ID Number 8 Transporters Phone <br /> a <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> inva.ro tec n/a 434-0211 <br /> 2480 athen ave <br /> Lincoln , ca <br /> 11 Waste Shipping Name and Description <br /> 12 Containers 13 14 <br /> Total Unct � <br /> t No Type Ovanuty 1rdtNo1 <br /> a non hamliquid 001 tt 3000 q <br /> G b <br /> �j <br /> E <br /> T N <br />`j E <br /> AI <br /> A c <br />�Y T h <br /> R r, <br /> s <br /> d " <br /> i <br /> t � <br /> t, <br /> D Additional Descrip,,ons for Mate ials Listed Above E F'andiirg Codes for Wastes Listed Above <br /> purge eater from tank <br /> r <br /> 7,L,5 Special Handlirg Instructions a^d Add uorai!norma icn <br /> r <br /> ems <br /> troy 17 <br /> abco 916-826-3803 ' <br /> I - <br /> I <br /> 6 GENERATOR S CERTIFICATION I cEri y `e r_er=s descnbed a�o�e or ^c'riar es are no ttrecl io feceral eou'. c^s for eponinc proper d spcsal o r-lezerdous%"as e <br /> Prinied7vpeoNar-e Sigra s r^vnh Day year <br /> T 17 Transpertcr 1 Acknov'edeer-En<.i Receipt of k,aie a s <br /> R — <br /> N Printeor7vped Name I S gna,ure o-+n Day dear <br /> S t_,.�,_ 5 2 91 n <br /> O18 ;ransporie,2 ACknot ledgemenl of Rece pt of Miater a's —_ <br /> EPirrtad,7yped Name Sigra ure Monro Da, y«r <br /> R <br /> f 19 Discrepancy Indication Space <br /> 1 <br /> F <br /> A <br /> C <br /> I <br /> L 20 FaCilrty OiNner or Operator Certification of receip,of%,aS,e materials covered by th s mani'e�l except as no ed in Item 19 <br /> 7 i <br /> Pli�g�,(I/N.me Sign boon n Day 1eaL - <br /> Pnnled by J J KELLER 8 ASSOCIATES INC 12-BLS-05 {ACV ZS8 <br /> Neenah WI 54357 0368 <br /> ORIGINAL - RETURN TO GENERATOR <br />
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