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SR0084501 (7)
EnvironmentalHealth
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12 (STATE ROUTE 12)
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2900 - Site Mitigation Program
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SR0084501 (7)
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Last modified
11/19/2024 3:48:05 PM
Creation date
10/18/2022 9:36:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
SR0084501
PE
2903
FACILITY_ID
FA0026861
FACILITY_NAME
PLASTAKET MANUFACTURING CO INC
STREET_NUMBER
6220
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
APN
04912002
ENTERED_DATE
11/18/2021 12:00:00 AM
SITE_LOCATION
6220 HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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November 2021 <br />Project No. 21-6640 <br />Page 6 of 8 <br /> <br />All site personnel have read the above plan and are familiar with its provisions. <br /> <br />FIELD MEMBERS NAME/AFFILIATION SIGNATURE <br />SITE SAFETY OFFICER Daniel Villanueva / Evan <br />Schmidt <br /> <br />FIELD TEAM MEMBER <br />FIELD TEAM MEMBER <br /> <br /> <br /> <br /> <br /> <br /> <br />ROUTE TO HOSPITAL <br />FACILITY NAME: Dameron Hospital: Emergency Room <br />ADDRESS: 975 South Fairmont Avenue, Lodi, CA 95240 <br /> <br />PHONE: +1209334-3411 <br /> <br /> <br /> <br />
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