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3500 - Local Oversight Program
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PR0545484
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Last modified
3/10/2020 11:13:08 PM
Creation date
3/10/2020 11:03:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545484
PE
3528
FACILITY_ID
FA0003714
FACILITY_NAME
LACHHAR CHEVRON*
STREET_NUMBER
334
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
RIPON
Zip
95366
APN
26115041
CURRENT_STATUS
02
SITE_LOCATION
334 E MAIN ST
P_LOCATION
05
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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rux copy of Lab Report and COC to Chevron Contact: O No <br /> •` 9-1452 Chai —ofi—CUStod —R °cor <br /> Chevron Foelllty Number Brett Hunter " <br /> Foollity Address 334.E. Main St. , Ripon, CA Chevron Contact (Name) <br /> Chevron U.S.A. Inc. (510) 842-8695 <br /> Consultant Project Number-- 7�o / —�/ (Phone) '. <br /> P.O. BOX 5004 Blaine Tech Services, Inc. laboratory Name Sequoia <br /> Son Romon, CA 94583 Consultant Nome <br /> Addre.. 1680 Rogers Ave. , San Jose, CA 95112 loborotory Release Number 9033828 <br /> FAX (415)842-9591 <br /> Fran ThiSamples Collected by (Nome) 4- <br /> e <br /> Project Contact (Nome) Colieotlon Date <br /> (Phone)408-573-0555 (Fax t4umbor)408-573-77,71 <br /> Signature T� <br />! tl e 1 �f�(Z�—1 Malyeas To Be Performed n <br /> . g h DO NOT BILL <br /> PP V <br /> x ato <br /> JE- o t 1`q d o <br /> `ea to rR3c <br /> .B• E J I re n 2% •f o o x 'li'� «o �O O `,C W <br /> (/7 � y C ^ <br /> ii ) X <br /> 7, N� H �= <br /> R a. Il I.S 2 Z; 1 <br /> Remarks <br /> Y x <br /> l�71rJi -� K <br /> x <br /> r►tw y `o `/�OX x C-JO <br /> r..r ` <br /> u (Signotur OrganizationUZ <br /> Keo Dy (Slgno • <br /> vg--rj ) Organization Dato/'Rmo 9/,/ Tum Around Time (Circle Choice) <br /> W (�9 • -P � W 47 � 24 Hrs. <br /> OrgonlzoUon Dal•/71me Received Dy (Signature) Or onizolion Dols/Time <br /> 48 lire. <br /> y" 5 Days <br /> rhod Dy (5lgnolunr rganizatloh Dat•/nme R•ci•vd For laboratory Dy (Slgnoturs) 10 Days <br /> \ Dols/Ilme <br /> IAs Controoted <br />
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