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ARCHIVED REPORTS_XR0002114
Environmental Health - Public
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EHD Program Facility Records by Street Name
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H
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HAM
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2900 - Site Mitigation Program
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PR0001333
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ARCHIVED REPORTS_XR0002114
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Entry Properties
Last modified
1/29/2020 11:43:55 AM
Creation date
1/29/2020 11:21:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002114
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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SJGOV\sballwahn
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EHD - Public
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U Yes <br /> Fax copy of Lab Report and COC to Chevron Contact; C] No ' ( 14 3 ` C Qi —p f—CUSOd —RGCOC <br /> `�- r3Chevron Faollity Number Chinon Coniaot (Name) v G r <br /> FooWly Mddn.. L� NIS M LU�l C .� `a q2-- X69 <br /> Chevron U.S.A. Inc. 'J (Phone) <br /> Conaullant Project Number �`"� Z <br /> P 0 BOX 5004 ,`1� Laboratory Name vl <br /> ConauRant Name '�` Glu�`'�L ogV0 "P,,1 ter. Lf -(V U <br /> San Ramon, CA 94583 - --- Laboratory Retea.e Number <br /> Addr...�`1 jG fr1 bS�jn/ �U�. t 1�L�r✓�?, cr4 �r�� r <br /> FAX {415}842-9591 3r�� �����y 7-- Sample Collected by (Na G)]�.L <br /> Project Contact (Name) Colleotlon Date Z6 r b <br /> (Phone)("lJ ' Fax Number) bo 6SF���� Signature <br /> Ano"ea To Be Performed <br /> 0 <br /> 1C i�• Y <br /> s M x$ <br /> z � <br /> x vvo A +ior ^ vN � ung n �� <br /> 44 0 <br /> Remartte <br /> iJox-z Ado ( 044944— <br /> ( 04 <br /> 04 9404 94 <br /> X04 94 <br /> vx-3z1 s f� I�:y� X X �' k 6041946 <br /> RellnQy( By !NUM) Orpaniratton Date/time Reoelvad By (Signature) Orgonlratlon Date/Tlme Tum Around Time (Circle Choloe) <br /> 24 MrsReltrpufeired By (Signator) OrQanl:atlon bat <br /> i1nmo RecaNad By (Signature) Orgoni:aiion Dole/Time 48 Hre <br /> 6 <br /> ' ReltnQulahW By (Signotun) Oryonlxatlon Dote/Tlme Rao[W.Va Fo LoberaD <br /> MOM Daie/ilme Ae Contracted <br />
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