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Environmental Health - Public
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BENJAMIN HOLT
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2905
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3500 - Local Oversight Program
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PR0544110
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2019 5:09:00 PM
Creation date
2/6/2019 4:14:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544110
PE
3528
FACILITY_ID
FA0003712
FACILITY_NAME
CHEVRON STATION #94275*
STREET_NUMBER
2905
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09760004
CURRENT_STATUS
02
SITE_LOCATION
2905 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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Fax copy of Lab Report and COC to Chevron Contact: O No C�S L l , <br /> Chain—of--Custody—Recork. <br /> Chevron Facility Number 7"`! Z7 Chevron Contact (Nome) �c��,1 <br /> Chevron U.S.A. Inc. , <br /> Facility Address 2 9 o S. 3!2- 151111:^ !lc,l-f LAY'. (Phone)-- 3 qa O pc/o V q <br /> P.O. BOX 5004 Consultant Project Number U'z 3 LD �ztf I <br /> Laboratory Nome -SUpQr`,'r.,r /4.0r,(;d C � I <br /> San Ramon, CA 94W Consultant Name C r`o- -7;LCL,^ f C 0. <br /> � Laboratory R . <br /> Release Number j 6 :3C) <br /> FAX (415)842-9591 Address t `�y i I-jn Cii<' v d Cir r`I �� Lu".5 a� q5 G`?! Samples Collected by (Nome) rHGI. <br /> Project Contact (Nome) Collection Date ; -7 <br /> (Phone)9 16 Number)` /G' 3'7 2'0 iv`'r Signature <br /> Anolyeee To Be Performed <br /> e <br /> ` o e <br /> �� <br /> 'eg R� <br /> cuo � 0 <br /> ea- a <br /> M a o oeDO; $N <br /> E a ° 0" Qc� N 34 <br /> ' � F ° 0 7:tov ` <br /> ,9 3 za3 00 � 5 rkoan ? mas \ <br /> w�v 7 S 1310 f-!c e, 1' ✓ O,7II) 'Q fii•luJ; --.-``�.► <br /> 3 G /3d�� l-J c L ✓ f�Jin, ' <br /> 7 �' <br /> r1 -v � � S S ;3 U 1-(C.C. ?� ✓ 'Vt11r� E'Sl��, '%r).:7rt)�r -- �`--. _,�... � <br /> 3 5 G % 34v i-(CL Y ✓ �o ` l.: c:t;� " <br /> l, <br /> ✓ <br /> Np i/ 3 5 G <br /> Reflnqulshed By (Signature) Oryanizotlon Dote/lime R elv d <br /> /til+^• L j/L^ r)L 7j Z U 7 (S1to <br /> ! Organization Date/Time Tum Mound Time (C <br /> ircle Choice) <br /> o +1'21 24 Nn.. <br /> R7ffiti hed Si oturo� Organization Date( q ' /Time ReceNod By (Sign Vie) ganlzotlon Dote/ilms 48 tin. <br /> �, <br /> 1Z o <br /> Relinquished By (Slgga4un) gonlzation v Dote/nme Reolyved For Laboratory By Signature) Date/nme � � <br />
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