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ARCHIVED REPORTS XR0000338
Environmental Health - Public
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EHD Program Facility Records by Street Name
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B
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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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ARCHIVED REPORTS XR0000338
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Entry Properties
Last modified
2/7/2019 10:09:44 AM
Creation date
2/7/2019 8:09:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000338
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
Scanner
WNg
Tags
EHD - Public
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Fax c Yes <br /> of Lab Report and COQ to Chevron Contact WU <br /> No Chain-of-Custoo-Record <br /> Chevron Facility Number 9-4275 Chevron Contact Name) Brett Hunter <br /> Chevron Products Co Facility Address 2905 W Benjamin Holt Dr, Stockton (Phone) (925) 842-8695 <br /> P O BOX 6004 Consultant Project Number cjr Laboratory Name Sequoia <br /> San Damon, CA 94583 Consultant Name Blaine Tech Services, Inc Laboratory Service Order 9144488 <br /> FAX (925)842-8370 Address 1680 Rogers Ave , San Jose Laboratory Service Code ZZ02790 <br /> Protect Contact(Name) Scott Boor Samples collected by (Name) <br /> (Phone) 408-573-0555 (Fax) 408-573-7771 Signature <br /> State Method ❑ CA ❑ OR ❑ WA ❑ NW Series ❑ CO ❑ UT Remarks <br /> U Cn <br /> Q N <br /> L 00 U3 <br /> C <br /> G Q U 0 = !L1 .O N U <br /> @ rl Ir @ i- O Q U C N D Z <br /> + 03 <br /> E U QU w + m o _ w U 21 t7 O U) Q N W ! 1 <br /> Z o 2 a �' Fm- d °' m °= m w A m w <br /> LJJ <br /> M E + aD ro s m 0 a c� <br /> X o Xo u� °� o d�ic� vo U o , p T 2 i7 <br /> l u E m w W � y mn oft- R, mr` mN mU Xo Xo <br /> Z :E(n N o mm m � i4- �Q 0 a � a � w ° 0 � 2C) ca m � a Lab Sample No <br /> 0 3 W Ild -Iry <br /> -�-r� oaf <br /> i <br /> t '--' r J `g K - <br /> I <br /> ul <br /> z <br /> Rely�uis d Sy(Signa e) Organization D t lTimr� ' R rued By ( n ure) Organization DatelFime /�/ Iced Y!NMTurnund ETime(Circle One) <br /> t�– �Lc �� Jc r � D CS�j i� 24 Hrs <br /> Feb ishe y(S t ) Organization Oa !Time 1 Rved B (Si afure��)' 0 ganization Date irme �} Iced YIN 48 Mrs <br /> 5 Days <br /> lRe inquished 8y{5*p^'�..:�^— Organizatron Date ime Re6i dd-Fes t_alooratot�5rgn2ture} Datelrrme iced YM 10 Days <br /> As Contracted <br />
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