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ARCHIVED REPORTS_XR0002116
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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H
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HAM
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236
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2900 - Site Mitigation Program
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PR0001333
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ARCHIVED REPORTS_XR0002116
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Entry Properties
Last modified
1/29/2020 11:48:11 AM
Creation date
1/29/2020 11:22:44 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002116
RECORD_ID
PR0001333
PE
2950
FACILITY_ID
FA0004067
FACILITY_NAME
CHEVRON SERVICE STA 9-4183 (INACT)
STREET_NUMBER
236
Direction
N
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03710028
CURRENT_STATUS
02
SITE_LOCATION
236 N HAM LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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Fax y of Lab Report and COC to Chevron C*act. a Noes <br /> chain—of—Cusf --Record <br /> Chevron Foa[lity Number ``Ll 1 D Chevron Contact (Name) k . <br /> Foolllty Address l.c)I) 1 <br /> Chevron U.S A Inc. Consultant Project Humber 1�' (Pho�) <br /> P 0. BOX 5U04 �G� � v �� �a�� taborotory Name 5 UO J <br /> San Ramon CA 94583 Consultant Name oe <br /> ' , � Laboratory Release Number <br /> FAX (415)842--9591 Address '7 it ee co Lw'AlD GA. <br /> --i—°° Samples Collected y Name) <br /> Project Contact (Name)�.r,70 ft47 M/0 U-164-y _ Collection <br /> 65�-6��z <br /> {Rhonea _(Fax Number4� 6S�' � Slgnatun <br /> Malyece To Be Performed <br /> t z a <br /> F <br /> r s r a $ <br /> � Remarks <br /> In 7- <br /> -� <br /> y-c- 1 - /13T y <br /> - p 1 ,yl 7 a( ►� 7p1l-G <br /> P-1 . / S b <br /> P Z s' b Z 3y y <br /> s D 1z s <br /> y X <br /> Ob Retina By (S] at Organlsatlon Dob/Time Reoehrsd O s'I AY <br /> (�r I] By (signature) organlmtion to m• <br /> /� Turn Around time (Chole Cholac) <br /> 24 Hire <br /> Relinquished By (Signature) orgarhatlon Date/Time Ren lgnalurc) organization I Date/Time 48 Fin <br /> �x <br /> a S Day* <br /> Relinquished By (Slgnaturv) organlsatle Date/Time Rcaleved For Lo o to pays <br /> �J rY By (51gn r ) Date me <br /> 7d 9b l� de) As Contracted <br />
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