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EHD Program Facility Records by Street Name
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6421
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2900 - Site Mitigation Program
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PR0522496
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Entry Properties
Last modified
2/15/2019 4:18:00 PM
Creation date
2/15/2019 2:47:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
WORK PLANS
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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Tags
EHD - Public
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CHAIN Vr ` "" <br /> Date 4" Z, 51— Page of <br /> LO <br /> Advanced <br /> N l Inc. __ <br /> GeoEnvironmental, Z <br /> fc1 _ Tests Required <br /> .TF 4005 Norlfi Wilson Way Stockton.Calilomia•95205•(200)467-1006- Fax(209)467-tt I <br /> Project Manager <br /> T Cv Irf <br /> Client F L A G t',.� Phone Numtyb er ,ti <br /> nvoice: <br /> Cab � <br /> 2oq - 4 6 ! AG6-� <br /> a Samplers: (Signature) Client D <br /> � • <br /> m /r / <br />°' 4111�rolectName � 1 Sample Type No. of �o Notes <br /> Solid <br /> Location Date water 6179 <br />� Coats. <br /> Time Air <br /> m Comp. Gt ab. r <br /> M Sample Description 3 V Q% <br /> Number <br /> DPM CS riI. Dr7n Krn5ID <br /> .t •q 2"SO <br /> WEI <br /> N <br /> 0 <br /> V <br /> W <br />(n <br /> n <br /> to <br /> N ICE11� PRESERVATION <br /> NEApSPACE AB ENT_�L CONTAINERS D°111 <br /> -q' <br /> \ . 2 -45 - o <br /> ecerve y: .gnaws N' <br /> a <br /> i nalur �— <br /> m e Y 9 DalelTlme <br /> inquis a <br /> U R ved by, (S net 1 <br />"it nalura) - <br /> Relinquished Y' <br /> a <br /> Mobile Laboratory for field anaiysrs' (signature) Date/time <br /> or Received by <br /> N <br /> C nature) Received for Laboratory bY' <br /> Q � Relinquished by: (Si9 DalalTima <br /> �u i ' 1 <br /> 'i Si nalura) Laboratory Name C <br /> d I Dispalcnsd by l 9 M (by authorize <br /> work. <br /> w authorize the Detl orm ante of the above indicate <br /> I hereby <br /> ti Method of Shipm^L p Vel rJI li fC..0 • n - <br /> �,, <br /> Special Instructions' <br /> c <br /> r <br />
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