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ARCHIVED REPORTS_XR0006359
EnvironmentalHealth
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6633
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2900 - Site Mitigation Program
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PR0528433
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ARCHIVED REPORTS_XR0006359
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Entry Properties
Last modified
4/7/2020 1:03:31 PM
Creation date
4/3/2020 4:37:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006359
RECORD_ID
PR0528433
PE
2957
FACILITY_ID
FA0019174
FACILITY_NAME
CHEVRON SERVICE STATION 9-6171
STREET_NUMBER
6633
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09741048
CURRENT_STATUS
02
SITE_LOCATION
6633 PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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_�` ❑ Yep <br /> �q�a v as -42 <br /> ax�Py of Lab Report and COC to Chevron Contact: ❑ No -Chain—0 "'C S 0Jv—RecoL(. <br /> —6171 Chevron Contact (Name)BRETT BUNTER <br /> Chevron Factltly !lumber (925) 842-8695 <br /> Facility Addnn 6633 Pacf F i (phone) <br /> IVrnn Pro 60 Co. Caneullonl project Humber ��D 2 Laboratory Hama SEQUOIA <br /> pox soot `"` <br /> Coneullonl }lame BLAINE TECH SERVICES INC. Laboratory Service Order 9144488 <br /> I Ramon, CA 94583 1680 ROGERS AVE. , SAN JOSE Laboratory 5arvlae Cade <br /> { (925)842-8370 Addreee /3, <br /> r <br /> Project Cantacl {Nome) CHRISTINE LILLIE Samples Collected by (Name) _�. <br /> (Phone) 40$-573-0555 (Fox thlmbar) 408-573-7771 Signature_ — <br /> State Method. ❑ CA ❑ OR ❑ WA ❑ NW Serles ❑ CO ❑ UT Remarks <br /> <� ++ <br /> isl <br /> N� Lab Sample No <br /> fir,✓fit' 3 !.c�' z Ss -'y <br /> IS- <br /> -4L, 3 sf <br /> -J <br />� � 1 <br /> ndehed By (Sl nalure) Organlzallon ale/Tlma Received By (Slgnalurs) Organization Data/lime load VN Turn Around lime (Circle Choice) <br /> 24 I-Irs <br /> 48 Hre <br /> fed By (Signature) Organlzallan paU/Tlma Reanlved B ,(5 at6id Orgonlzallon bola/Tlma tae Y N b Days <br /> C U�z� C iJ 10 pays <br /> BY (Signature) Organization Dole/time eclnved Far Laboratory By (Slgnalure) Dale/Time As Contracted <br /> lee fN <br /> !IV- 1/a <br />
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