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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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+• �* ��ti <br /> t X K <br /> s(F�rtq �ned'FO[t`ise 911tp 2�1td1)tYPawAter�� u �°' �'sri+�a'`�'�:�'.s <br /> 1210 :1456ii <br /> H <br /> NON-HAZARDOUS 1 Generators US EPA ID No Manilest Doc No 2 Page 1 <br /> WASTE MANIFEST N A 0001 1 of 1 <br /> 3 Generators Name and Mailing Address <br /> cheveron <br /> lode. , ca hwy112 r <br /> 4 Generators Phone( 209-467-1006 att tim <br /> s 5 Transporter 1 company Name 6 US EPA 1D Number A Transporters Phone <br /> inviro tec 434-0211 <br /> 7 Transporter2 Company Name 8 US EPA ID Number B Transporters Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> INVZRO TEC <br /> r <br /> 2980 athens ave <br /> lincoln , ca 4 <br /> 12 Containers 13 14 <br /> 11 Waste Shipping Name and Description Total Unit ±� <br /> No Tvpe Quantity WVVoI <br /> a <br /> _ non haz waste liquid nos 001 tt g <br /> _ A waste water <br /> i G b " <br /> E r <br /> y N <br /> rzA <br /> A <br />[ A c <br /> i? O t'A1 <br /> r R <br /> d <br /> I - <br /> D Additional Descripoons for Ida e ials Listed Above E handling Codes for iNastes Listed Abo e <br />! puge water from tank <br /> r <br /> 18 Special Handling irsrructiors and nddnional lnforr a ion <br /> f eme.rg <br /> abco troy w 916 826 3803 <br /> f <br /> r <br /> V. <br /> t <br /> 16 GENERATOR$CERTIFICATION Ice-.y I`c T s ce Scrinec ^^}e c- tis nan esi are nc G eci o feae sl c,)Lia ions or eporirg prCpe cispcsal c ri,laidos Yeas e <br /> Primeoi7yped Name S en- 110 n Jay }car <br /> TR 17 Transposer t AcKIMCAleegemc-i of Receip'of Heir a_ <br /> A Dnntec7yped fume 5i - Jie l'or.,i n_v �r <br /> ray <br /> O 18 Transporter 2 rckw v Ieegeme^t of Receip of lyra ei GIs <br /> R -- — <br /> T PnntedrTyped Name Sig-a u eI ronrh Ley Yvsr <br /> RL -� <br /> 19 Discrepancy Indical on Space <br /> F <br /> A <br /> C <br /> I <br /> 20 Facility Owner or Operator Cenihcaiion of receipt c'"as a materials cc%eyed by his mandcst except as noted in Item 19 <br /> Y <br /> Pnnled/Typed Name re t4on h 00v ear <br /> ENK0I _ G' r)- 1130 <br /> I'nnted by J J KELLER S ASSOCIATES INC 12-BLS-CS Rev 1219$ <br /> Neenah WI 54957 0368 <br /> ORIGINAL — RETURN TO GENERATOR <br />
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