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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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6421
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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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OC plete temp 1 and/or 2 for <br /> a Complete items 3,4a,and 4b etvic I also wish to receive the <br /> •Pnnt Your name and adtlreaa me follOWi fan <br /> miltoZ. <br /> f form a this eJdra( <br /> •Attach pais loan to the front of the malipleca,or on ow JJJJ <br /> Permit. spa not <br /> • a FlatuRe um RB6BI r F t � Addressee's Address <br /> .the eras, P eque 1. o r th a4clece 1 \ <br /> tlellveratl. Feceipt wAl show w wtwm the erpcle we 1 `J\ 2,0 Restricted Delivery <br /> fr Consult postmaster for fee. ti <br /> RICHARD BOKIDES 4a.Article umber <br /> BOKIDES FAMILY LTD PRTNSHIP 4b.Service <br /> 5421 W CAPITOL AVE We <br /> LODICA 95242 Registered d suredD <br /> ❑ Express Mail Insured � <br /> Q R f <br /> 7Dat rch 11 COD <br /> . <br /> 5.Received By: 8 <br /> Y (Priot Name) <br /> 8.Addressee's Address(OniY'q <br /> and tee is <br /> CC <br /> : requested ,Y <br /> 6.SignatureA ressee or Agent) <br /> J <br /> a°. X <br /> PS Form 38 1, December 1994 <br /> +02595-98.8-0229 Domestic Return Receipt <br />
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