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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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WNg
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EHD - Public
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� Advanced CHAINO CUSTO <br /> DAECORD <br /> == GeoEnvironmental, Inc Date �� Pace or y <br /> 897 Shaw Road- Stockton California 95215- (209) 467 1006 Fax (209) 467-1118 <br /> Client (� r G1 z` - � Project Manager Tests Required <br /> C C-�(o-v <br /> �Oneum r <br /> Sam p s (Signa N <br /> re) i Invotce <br /> AGE <br /> Project Name �( �('\ Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of / <br /> Notes <br /> Number Description comp crab Air Conts <br /> td;k!�; <br /> csyl�Ay(� <br /> -3, <br /> - tom <br /> e inqu� ( i tore} ) ecerve y ignalure Date171 <br /> OL-E-1-yiely It <br /> Relinquis y (Signature Received by (Signature) Date rime <br /> XG'S!P Vic,Relinquished {FA69P7W-WA)BSENF — CONTAjAtfff� ived by Mobile Laboratory for field analysis (Signature)GOOD COND DalelT�me <br /> DECHLOftJhfAt EI)fkr L PRESERVED IN <br /> te�Time <br /> Dispatched bg0�W%K"0-r Date-rime R for Laborator <br /> Method of Shipment Lib story Name <br /> LA <br /> I hereby authorize the p`e mance,d a above Indicated work <br /> Special Instructions <br /> �r <br /> RECD SEALED&INTACT VIA <br />
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