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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
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EHD - Public
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-1 a�n: rnrx�^'�«I-.-»s4�"-�-rs�Y-:"',rYs+'0.^.' �•-^s e��f'_l�wn-�1;�',�y�"`^ a��� � rr' -- * ' <br /> Form es4 ed for use on �- ,t, y <br /> � 9n elle jig-pitch)typewriter)-- <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manifest Doc No 2 Page 1 <br /> -' WASTE MANIFEST n/a 0001 3oi 1 <br /> b' 3 Generators Name and Matlmg Address <br /> cheveron lode , ca <br /> L harry 12 att; tom <br /> ` a Generators Phone(209 )467-1006 <br /> 5 Transporter 1 Company Name 6 US EPA ID Number A Transporter s Phone <br /> thrifty rooter n a 434-0211 <br /> 7 Transporter 2 Company Name S US EPA ID Number B Transporler s Phone <br /> 9 Designated Facility Name and Site Address .0 US EPA ID Number C Facility s Phone <br /> inviro tec <br /> 2480 athens ave. <br /> lzncoln, ca n a 434-0211 <br /> 11 Waste Shipping Name and Descnptron 12 Coraalners 13 14 <br /> Total Unit <br /> No Type Ouantliy VWVof <br /> r <br /> a <br /> non haz waste liquid nos <br /> waste water 2 <br /> G b <br /> E <br /> N <br /> R <br /> A c <br /> T <br /> O <br /> R <br /> d <br /> D Acdwonal Descripoons for Wto Gals L Sed bo%e E N2ndhng Gcoes for Vt'astes Lis.ed Abe�e <br /> purge -eater from drums <br /> .5 Specht HGndling lns,rL C ions and Adai.ICnal 111"o rc c^ <br /> emg ; ; abco <br /> troy -,r. 916-826-3803VIT <br /> t <br /> 16 GENERATOR S CERTIFICATION I CL-`y 4he r-,E =cesc.`cd arae-r =r-G-lest..e rot=,r ec c eco a' ecL�I= ,rs or reprr no p.oper a spc=,I o Hax,rro„s 1'cs e <br /> i <br /> P in ed TN fed f lame I &gnalu e l+or.h <br /> i <br /> T i 17 T anspo-er 1 Acknc� edcement of Recclpr of tfa e -s - ,� _ 4 <br /> R <br /> A PnnledrT%ped 1•ic,me „'�na!./ r � � ._. n� '� h Cao `e r <br /> P BILL ARTAMER"'KO � -� <br /> d 8 Transpo'ter 2 Ac,ncwledeernent of Receipt of Mc e F's <br /> R c 7+on1h 72 Year <br /> T Pr�nsedr'T�ped Name Icnalure ) <br /> E � rY <br /> R I <br /> 19 Discrepdncy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> Fac.l.lyO�+ner or Operator Cen'icat,on of rece pt o`%Nasse reale.ass cepe ed by Ih.s mandesi except as noted.n Item 19 <br /> 120 <br /> Pnnted'T}ped Name � $ig�i�� �^ ra Day rear <br /> BILL ARTAMENKO <br /> Pnnled ty J J KELLER&ASSOC{ATES INC 12-13LS-05 Rev 12M <br /> Neenah WI 54957 0+68 <br /> TRANSPORTER O <br />
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