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SITE HISTORY
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0001333
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SITE HISTORY
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Entry Properties
Last modified
1/29/2020 11:45:59 AM
Creation date
1/29/2020 11:14:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE HISTORY
RECORD_ID
PR0001333
PE
2950
FACILITY_ID
FA0004067
FACILITY_NAME
CHEVRON SERVICE STA 9-4183 (INACT)
STREET_NUMBER
236
Direction
N
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03710028
CURRENT_STATUS
02
SITE_LOCATION
236 N HAM LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Yes oy <br /> Fax c-a- PY" o - _ab Report and COC to Chevron Contact('] No Chain—of—Custody-Clecord <br /> Chevron Fe4ty Number L l� Chevron Contact (Name) <br /> Foolllty Addrssr 2 (Phone) .S�d~ �Lf <br /> Cheyron U.S.A. Inc. <br /> P.O. SOX 5004 Consunont ProJeot Number ���r Lobotvtory Name T � <br /> Consultant Name Pacific Environmental G r o Laboratory Release Humber . 3 <br /> San Ramon, GA 9583 2025 GatewayPlace Ste.440 San Jose u s <br /> FAX (415)842-9591 hddre.• Sampt•• Col[rcted by (Name) <br /> gillu <br /> Frojoct-Contact (NdmaF ��'"�- Co1lecUo ah Z Z G ^ <br /> (Phon1) (408 44-jL-25)Q0 Numb.,) 441 — Slgnatur• <br /> M0iy1.1 To Be Performed NO'T'E <br /> DO NO <br /> a CBILL <br /> TB -LBxSpMPLE <br /> g <br /> 0 <br /> 4 <br /> a $ o * n v ! 'a <br /> E. _. o ro t,.o,- -° s _ _ >S _ ,-e n- o a.. .. o^ <br /> s 4 : __c� -- Tom` a* o �eQ+_ <br /> z N� r Cc) <br /> a $ $ $ �.. W �:. Remarks <br /> VA W <br />�w-3 (50') <br /> W- <br /> V,W-q w <br /> -V,w-qw y <br /> ltllnqulshrd By (S •) 0rgonixaUoon. R/ats/Tlme • (S nature Orrt <br /> otlon. /Do sl nm• Turn Around lime (Circle Choloe) <br /> "g`� - -1`-7m'-u'Cha /�� 24 Hn. <br /> loll qu ( naturr) OrrnlicUon Da /T1m ,J{�( • Mrd (S n tur• organl otlon D t 48 Hrn. <br /> � i 7l�r bolo 6 °oy' <br /> e oayl <br /> ielnq lsh•d By (5lgnoture) Organlsctlon Act./"ism. jaborotory By (5lgnatun) pati/71 • As Contracted <br />
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