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2900 - Site Mitigation Program
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PR0522496
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/15/2019 5:26:40 PM
Creation date
2/15/2019 2:44:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0522496
PE
2957
FACILITY_ID
FA0015317
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95245
APN
05532024
CURRENT_STATUS
02
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Run by : STAFF SAN O*JCOUNTY PUBLIC HEALTH SERVICES <br /> Report #5021 I- 4=1GI_ ..T -!ON as of Y iNFORMA7Q:8/O*4 <br /> T - - <br /> Make changes/corrections in RE pert or pencil: <br /> OWNER FILE INFORMATION Date of INFORMITION CHANGE: <br /> Date of OWNERSHIP CHANGE: <br /> OWNER ID: 001987 New Owner IN 00._.____................Owner Name: CHEVRON IJ^ <br /> Owner DBA: CHEVRO SR <br /> Owner Address: 2410AMINO RRMON <br /> ^a R) RAMON, CR 94583 /��/Q�{��f e G•C,�CniC// <br /> Hose Phone: 0-842-8695 15 <br /> Work/Business Phone: 209--956--2520 <br /> Mailing Address: F'U BOX 04 ��� - - <br /> Care of: PAT KIN/F'ERMI7 DESK <br /> SAI RAMON. CA 94583 <br /> FACILITY FILE INFORMATION y <br /> FACILITY ID: 0040 19A`� <br /> Facility Name: CHEVRON USA <br /> Location: 6421 PADDOCK F' <br /> L <br /> 95240 <br /> Phone: m• C / �/�� <br /> LODI 95240 <br /> / <br /> Mailing Address: CL BOX 4 <br /> Care of: <br /> CLI <br /> S RAMON, CA 94583-0804 <br /> Location Code: 02 APN: <br /> BO5 District: 02 SIC Code: __. ............._._____.. <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> ACCOUNT IN 0003650 New Account ID: 000 .......... <br /> Mail Invoices to: F-"aci ' y Mail Invoices to: 0 er <br /> Account Name: <br /> CH " RON USA <br /> Account Balance as of 8/05/94 : $ 0. 00 <br /> FILES LINKED: No WATER SYSTEM FILE linked <br /> Record MT(s) Transfer to Activate / Inactivate <br /> P/E Description ID Employee Status Linked new owner? Delete <br /> ------------------------------------------- ---- <br /> ----------------------------------- <br /> ^2950 N ASSESS PR001706 0684 INFURNA IN�1B1�IVE Y N A T D <br /> --3526 LO ------------ ----------,�ccvs,`--------------------------------- <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or anent of same, acknowledge that all site and/or <br /> project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the <br /> BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all aoolicable SAN JOAQUIN <br /> COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date � <br /> ..._._ / / ._ <br /> ---------------------- <br /> Programs to be TRANSFERED: .... __ _ x $20.00 =_........._.-__...__.__ Amount Paid __. Date -/____-._/9._...._. <br /> Payment Type .. - - — Check 1< ... - - --.._ Recvd by . -.._.._........__ <br /> ------ -. --- ------ <br /> REHSorCOUNTER SUPV: !_,,,_ Date . ,/5_/9 ACCT out Date_!D/ _._/9[, UNIT/File:,_. <br />
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