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ARCHIVED REPORTS XR0000648
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 XR0000648
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Entry Properties
Last modified
2/15/2019 9:28:37 PM
Creation date
2/15/2019 3:09:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000648
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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EHD - Public
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( Advanced CHAIN OF CUSTODY ECORD <br /> k' w--Date Page � Of-' <br /> f - <br /> %'Y GeoEnvironmental, Inc t <br /> 837 Shaw Road Stockton, California -95215 - (209)467 1006 - Fax (209)467 1118 <br /> Client Project Manager <br /> Tests Required <br /> ne 4Z � r � L7 <br /> v <br /> '71o'7 <br /> a I�rs <br /> (S gnat j Invoice <br /> Project Name -- U,/— �� �,���� 7 � , AGE 'Client ] <br /> L <br /> Sample Location Date Time Sand Water Sample Type No of Notes <br /> Number Description Camp Grab Air Conts <br /> YiA'62 Z-3 �,4 <br /> V J <br /> mins el by nature eceive y ignature Date rm <br /> Cs(.k�t. �C,,3U <br /> �r <br /> Rei quished by (Signet yr Received b (Signature) 4atelTime <br /> OPMTS <br /> MER&hox <br /> I It <br /> Relinquish"th0 gVAMW%VNT fULN r3DLN eceived by Mobile Laboratory for held analysis (Signatura� ( �ate/T�me <br /> DECH1,0 ZINATED IN LAB y <br /> ��k <br /> n>rs crit <br /> t)aspatcfiedplfyE � rAri Qate(Time Recei ft Laboratory D lfime <br /> Method of Shipment � � r'n lJ a � LabWatorA N e <br /> Special Instructions ,R� 4—"- I he y authorize 116 pa mance of 1 e above indicated work <br /> F <br /> 4ACT VIA <br />
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