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ARCHIVED REPORTS XR0000647
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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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 e , <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> Geolnvironmental, Inc Date `� Page <br /> `... of <br /> 837 Shaw Road - Stoci,ton California-95215- (209) 467 1006 - Fax (209) 46/-1118 <br /> ClientIlC Cc tf p S ` Project Manager <br /> VL-,L- ITests Required <br /> �� � 1c <br /> Phone Number / <br /> -- Samplers Slgnatur�) r % <br /> Invoice <br /> Project Name � -' „a._�(�- <br /> �,` -e g tr`�, �� � AGE <br /> Client <br /> Sample LocationSample Type <br /> Number DBSCriptlon Date Time Water Solid No of Notes <br /> �.,�.. comp Grab Air Cion#5 <br /> ,'J Lia 1 Ll ?� ` <br /> LU tom( Ll <br /> in uis ac natur Receive y T9ignaturg U ta/Time <br /> Re inqurshed b (3'gnatur Recai d ��`I'�tAI .� J f n / ✓� ` -C <br /> A Sf75 Y IT COFJWNI RS___._._. Date ime <br /> I)FC"IILC)RIN k LD IN I AH_ P R 1,SE1W ED rN I A-a <br /> Relinquished by (Signature) Received by Mobile I a `� ry 'ii I is fgn8 ura) Datr:lTsrna <br /> PI2ESFIWA'TrC)N_ <br /> Dispatched by (Signature) Oate/7ima Received for Laboratory by Data/Time <br /> Method of Shipment � Laborninq Name <br /> Special Instiuctions w l ' b I lre <br /> Y author a porter ante of the above indicated work <br /> �'� � - <br />
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