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ARCHIVED REPORTS XR0000647
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CAPITOL
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6421
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2900 - Site Mitigation Program
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PR0522496
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ARCHIVED REPORTS XR0000647
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Entry Properties
Last modified
2/15/2019 7:51:52 PM
Creation date
2/15/2019 3:08:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000647
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
Scanner
WNg
Tags
EHD - Public
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i • i <br /> # Advanced CHAIN OF USYODY RECQRD <br /> GeoEnvironmental, Inc Date Page of cry <br /> 837 Shaw Road Stockton, California-95215 (209)467-1006 - Fax (209) 467-1118 <br /> Client r Protect lWana6er <br /> t.a.� ', Tests Required=— <br /> Phone NUrriber <br /> S Ear Su� tura)fy� invoice <br /> Project Name + ��J�'�- G-1 AE <br /> Client ❑ <br /> Sample location � SamPe Type <br /> Number Description Date Time _ Water Solid No of � Notes <br /> Comp Grab Air ContS <br /> 11,x,0 t(4 <br /> ort <br /> 41 <br /> _ eFellinq Is a y ( ature) � acer via Ibnalura <br /> ✓ ICF/r / Darl�Ime <br /> �Y <br /> GC'2D CONDITION / �f �� <br /> Relinquished by (Signature) r --•Td7°r' MU <br /> SENT l( � <br /> Received (��Ni 1 T.D IN LAB �i�RESERVEDSrtF LA Datefrlm <br /> Relinquished by (Signature) Received L"48i36/1wtE o fo raid ar aiys sIgna�irie} <br /> OatalTlme <br /> Dispatched by (Signature) Dale/Time <br /> Received for labor&tory by <br /> Da'eJTime <br /> Idfethod of Shipment Laboratory Name <br /> Calc r <br /> Special Instiuctions Irby su hhoriz a peri rma ca of the nbova indicated work <br />
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